Abstract
To determine the outcomes, safety profile, and efficacy of ultrasound-assisted catheter-directed thrombolysis for pulmonary embolism with right heart strain. The charts of 30 consecutive patients who underwent CDT as treatment for pulmonary embolism were reviewed. Risk factors for bleeding were noted. Indicators of right heart strain on computed tomography and echocardiogram, as well as degree of pulmonary vascular obstruction, were recorded before and after CDT. Thirty-day mortality and occurrence of bleeding events were recorded. Right ventricular systolic pressure decreased from an average of 53.1 mm Hg to 38.5 mm Hg (p = <0.001) and average Qanadli index of pulmonary vascular obstruction decreased from 49 to 34 (p = <0.001) after CDT. The average ratio of RV/LV diameter decreased from 1.48 to 1.17 (p = <0.001) The number of patients with RV hypokinesis decreased significantly (p = 0.016) from 19 (95% of those with available data) to 12 (60%). The number of patients with RV dilation decreased significantly (p = 0.031) from 19 (95% of those with available data) to 13 (65%). Nine (30%) patients had three or more minor contraindications to thrombolysis and fourteen (47%) had had major surgery in the month prior to CDT. No patients experienced major or moderate bleeding attributed to CDT. In our experience CDT proved effective in the rapid alleviation of right heart strain with minimal bleeding risk. Right heart strain is associated with increased mortality and long-term morbidity in pulmonary embolism and CDT may allow for a safe means of improving outcomes in submassive pulmonary embolism. We found CDT to be a safe alternative to systemic thrombolysis in patients with risk factors for bleeding such as prior surgery.Tabled 1Measures of Right Heart Strain Before and After CDTPre-CDT MeanSDPost-CDT MeanSDDifference MeanSDP ValueRVSP53.115.138.510.214.512.6<0.001RV/LV1.480.321.170.260.322.16<0.001Qanadli Index4918341315.410.1<0.001 Open table in a new tab
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