Abstract
Pulmonary embolism has become a cause of great concern to health care professionals. Despite strides in research and availability of sensitive diagnostic tests, the mortality and morbidity related to this entity continues to cause tremendous economic burden. Patients present with an array of symptoms ranging from mild dyspnea to hemodynamic instability and even death. Prompt recognition of symptoms along with early risk stratification can be lifesaving. Management focuses on achieving hemodynamic stability and reducing clot burden. Approved treatment modalities include anticoagulation, systemic or catheter directed thrombolytic therapy and surgical embolectomy. In this article we will review catheter-directed thrombolytic therapy, specifically the EKOS® or the EkoSonic endovascular system. EKOS® uses ultrasound-facilitated catheter-directed thrombolysis. The rationale behind this therapy is using shorter infusion times and lower dosage of the thrombolytic therapy, thereby reducing the complications associated with their use.
Highlights
BackgroundPulmonary embolism (PE) can be defined as the blockage of either the pulmonary arteries or its branches with embolic material that originates elsewhere in the body
Pulmonary embolism has become a cause of great concern to health care professionals
In the United Sates, the incidence of Venous thromboembolism (VTE) is about 900,000 which includes both deep vein thrombosis (DVT) and PE, with PE accounting for about 150,000-250,000 hospitalizations, and about 60,000-100,000 deaths annually [4]
Summary
Pulmonary embolism (PE) can be defined as the blockage of either the pulmonary arteries or its branches with embolic material (either air, fat, amniotic fluid or a thrombus) that originates elsewhere in the body. Biomarkers that are frequently seen are troponins which indicate myocardial injury and brain natriuretic peptide (BNP) or N-terminal pro BNP that suggests myocardial dilation [4] The presence of both right heart strain and positive biomarkers has been associated with increased mortality [6]. The EKOS system consists of an infusion catheter, an ultrasound core wire and a control unit (Figure 2) This technology uses high frequency, low power ultrasound energy in combination with thrombolytic therapy to achieve clot dissolution. The ultrasound uses cavitation-induced microstreaming which loosens the fibrin strands within the clot and enhances mechanical breakdown of the thrombus It increases the surface area of the clot, as a result more active plasminogen receptor sites are in contact with the thrombolytic agent. There have been multiple studies over recent years that have investigated the efficacy, benefits and adverse effects of thrombolytic therapy used in combination with anticoagulation versus anticoagulation alone (Table 1)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
