Abstract 14165: Ultrasound-Accelerated Thrombolysis May Be the Preferred Catheter-Based Lytic Therapy for Pulmonary Embolism

Abstract

Introduction: Pulmonary embolism (PE) is estimated to cause 100,000 deaths annually in the US. Systemic use of fibrinolytic drugs carries risks of significant bleeding. Catheter directed thrombolysis (CDT) delivers thrombolytic drugs directly to the site of the clot and in lower doses which may improve its safety profile. We aimed to investigate the safety and efficacy of CDT in intermediate risk PE and contemporary trends of follow-up cardiac testing in these patients. Methods: 75 patients who underwent CDT for intermediate risk PE at a single center from 2014-2021 were studied retrospectively. Outcomes included procedure related complications and mortality. Continuous variables are presented as mean±SD, categorical variables as percentages. Logistic regression and survival analysis was used. Data was analyzed in Stata/BE 17.0. Results: Demographics (Table 1), lab and imaging data (Table 2) were assessed for 75 patients. Troponin and BNP were elevated in 63.5% and 60% respectively. RV dilation was present in 86.7%. Ultrasound accelerated thrombolysis (EKOS) was performed in 80% and standard CDT in 20%. One procedural complication occurred, a patient undergoing standard CDT suffered a cardiac arrest and died. Major bleeding occurred in four patients but did not contribute to mortality. Mortality at 30 days and one year were 6.8% (5/73) and 13% (9/69) respectively. Only three deaths were attributed to cardiovascular causes. Those who underwent EKOS had 85.6% lower odds of death in 30 days (OR 0.14 (0.03-0.79), p=0.02) compared to CDT; however, our results are limited by a small sample size. Follow up imaging was assessed at 1 year (Table 3). Echo was most frequently performed in 45.3% of patients. Conclusions: EKOS for intermediate risk PE is a safe procedure with no procedural mortalities in our study. As follow up was poor, with less than 50% of the cohort receiving imaging, future directions should be aimed at ensuring these patients are monitored for long-term sequelae of PE.