“Radial” approach to high risk pulmonary embolism – transcubital catheter directed intervention as a first-line therapy in patients with clinically massive and submassive pulmonary embolism.

Abstract

2016;11(3-4):133. VII. nacionalni sastanak o kardiovaskularnim intervencijama s međunarodnim sudjelovanjem VI. sastanak intervencijskih kardioloskih medicinskih sestara i tehnicara Goal: Despite the guidelines, more than two-thirds of patients with massive/high risk pulmonary embolism (PE) do not receive thrombolytic therapy1,2. Submassive/intermediate risk PE, as defined by right ventricular failure and/or NT-proBNP/troponin elevation, which can result in life-threatening deterioration/sequel is treated with thrombolytic therapy even less frequently. The main reason, that thrombolytics are used infrequently despite the potential clinical benefit of rapid clot lysis, is respect for significant bleeding complications, since nonpathologic thrombi are also lysed. The reluctance of majority of treating physicians to actually use thrombolytic therapy in everyday praxis persist and is matched only by zeal to publish successfully treated cases by minority of interventional colleagues. “Radial” – transcubital approach to high risk pulmonary embolism and subsequent catheter directed intervention (CDI) is proposed as a realistic alternative to both routinely used heparin therapy and surgical embolectomy, that can with modifications even be used in the case of contraindications for thrombolytic therapy. The goal of this presentation is to present a real-life center experience of the feasibility and safety of CDI including protocol for transcubital CDI as a first-line therapy in patients with clinically massive/high risk and submassive/intermediate risk PE.