Abstract
Background Percutaneous catheter-based ultrasound-assisted thrombolysis (UACDT) is recommended for patients with intermediate-high-risk or high-risk pulmonary embolism (PE) in whom systemic thrombolysis has failed or is contraindicated. Aim To evaluate the safety and efficiency of UACDT in patients with intermediate-high-risk or high-risk PE. Methods Between October 2017 and January 2020, we performed UACDT using the EkoSonic™ Endovascular System (EKOS™) in 51 patients (21 males, age 63 ± 18 years) with a sPESI of 1.3 ± 0.7. The EKOS™-catheter was implanted within 24 h after admission. Over 15 hours, 11.5 mg of alteplase was administered per catheter. We evaluated right ventricular stress and cardiac biomarkers before and after UACDT. Results 24 h post-UACDT, median RV/LV ratio decreased from 1.13 to 0.96 (p < 0.001) and the mean sPAP decreased from 47 ± 3 to 32 ± 2 mmHg + CVP (p < 0.0002). There were 6 major bleeding events resulting in transfusion. No stroke, myocardial infarction, right heart decompensation, or recurrent PE occurred. 31 patients (63%) were discharged without any signs of right ventricular stress. After at least 3 months, 73% of our patients did not show any signs of right ventricular dysfunction. The mean RV/LV ratio decreased to 0.75 ± 0.03 (p < 0.0001) in comparison with pre-UACDT, sPAP to 23 mmHg + CVP (p < 0.0001), and BNP to 40 pg/ml (p < 0.0001). Conclusions The treatment with UACDT reduced right heart stress during the first 24 hours and midterm in patients with intermediate-high-risk or high-risk PE at an acceptable rate of severe complications.
Highlights
Pulmonary embolism (PE) is one of the most frequent cardiovascular diseases worldwide with an annual incidence of 39–115 per 100 000 population and is a major cause of cardiovascular mortality in Europe and the USA [1–4].Usually, PE is diagnosed with high sensitivity and specificity by computed tomographic pulmonary angiography [5, 6]
In patients with intermediate-high-risk PE, systemic thrombolysis resulted in a reduced duration of treatment on the intensive care unit as well as a reduced risk of haemodynamic decompensation and collapse and in an increased risk of severe extracranial and intracranial bleeding [10]
If intermediate-high-risk or high-risk PE with contraindications for systemic thrombolysis was confirmed according to the ESC guidelines, patients were either admitted directly to our catheterization laboratory or accommodated on our intermediate or intensive care unit [7]
Summary
PE is diagnosed with high sensitivity and specificity by computed tomographic pulmonary angiography [5, 6]. For patients with high-risk PE or haemodynamic deterioration on anticoagulation, systemic (rescue) thrombolysis is recommended by the ESC (European Society of Cardiology) Guidelines [7] as well as by the AHA (American Heart Association) [8]. In patients with intermediate-high-risk PE, systemic thrombolysis resulted in a reduced duration of treatment on the intensive care unit as well as a reduced risk of haemodynamic decompensation and collapse and in an increased risk of severe extracranial and intracranial bleeding [10]. Percutaneous catheter-based ultrasound-assisted thrombolysis (UACDT) is recommended for patients with intermediate-high-risk or high-risk pulmonary embolism (PE) in whom systemic thrombolysis has failed or is contraindicated. Aim. To evaluate the safety and efficiency of UACDT in patients with intermediate-high-risk or high-risk PE. We evaluated right ventricular stress and cardiac biomarkers before and after
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