Ultrasound-Assisted Catheter-Directed Thrombolysis in High-Risk and Intermediate-High-Risk Pulmonary Embolism: A Meta-Analysis.

Abstract

Catheter-directed Ultrasound-Assisted Thrombolysis (USAT) is a novel technology providing a high efficacy with a reduced bleeding risk in patients with pulmonary embolism (PE). We performed a meta-analysis based on presented or published PE series in which USAT was utilized. We searched the MEDLINE, EMBASE and the Cochrane Library for trials published up to December 2015. The primary outcomes were mean pulmonary artery pressure (PAMP), right to left ventricle diameter ratio (RV/LV ratio) and computed tomography (CT) obstruction score. The secondary outcomes were all-cause and cardiovascular mortality, major and minor bleeding episodes and recurrent PE. The 11 trials (n=553) and 15 trials (n=655) met eligibility criteria of primary and secondary outcomes, respectively. USAT was found to significantly reduce PAMP, RV/LV ratio and CT obstruction scores. After adjusting for baseline covariates in meta-regression analysis, male sex and number of high-risk patients were found to be associated with PAMP and RV/LV ratio while only male sex was associated with CT obstruction scores. The pooled incidence of all-cause and cardiovascular mortality were 3.2% and 2.2%, and the incidence of major and minor bleeding episodes were 5.5% and 6.9%, respectively. In the pooled analysis of the remaining trials, the incidence of recurrent PE was 1.7%. USAT compared with three randomized thrombolytic trials showed a similar death rate with a lower rate of major bleeding. This meta-analysis confirmed that USAT significantly reduced PAMP, RV/LV ratio and CT obstruction scores with similar death rates and a lower risk of major bleeding compared with patients with PE undergoing systemic thrombolytic treatment.