Abstract
Pulmonary embolism continues as a very common and also presumably life-threatening disorder. For affected individuals with intermediate- as well as high-risk pulmonary embolism, catheter-based revascularization procedures have developed a possible substitute for systemic thrombolysis or for surgical embolectomy. Ultrasound-assisted catheter-directed thrombolysis is an innovative catheter-based approach; which is the main purpose of the present review article. Ultrasound-assisted catheter-directed thrombolysis is much more efficacious in reversing right ventricular dysfunction as well as dilatation in comparison to anticoagulation alone in individuals at intermediate risk. However, a direct comparison of ultrasound-assisted thrombolysis with systemic thrombolysis or surgical thrombectomy is not available. Ultrasound-assisted thrombolysis with early intrapulmonary thrombolytic bolus could also be successful in high-risk patients, but unfortunately, data from randomized trials is limited. This review article recapitulates existing information on ultrasound-assisted thrombolysis for acute pulmonary embolism.
Highlights
BackgroundPulmonary embolism (PE) is one of the leading cause of mortality in the United States (US), accounting 5-10 % in-hospital mortality, 15% 90 days mortality and 58% mortality in the first hour in patients with hemodynamic compromise [1,2,3]
For affected individuals with intermediate- as well as high-risk pulmonary embolism, catheter-based revascularization procedures have developed a possible substitute for systemic thrombolysis or for surgical embolectomy
For low-risk PE anticoagulation and early discharge is recommended and for intermediate to high-risk PE intensive care unit (ICU) admission and intervention is recommended
Summary
Pulmonary embolism (PE) is one of the leading cause of mortality in the United States (US), accounting 5-10 % in-hospital mortality, 15% 90 days mortality and 58% mortality in the first hour in patients with hemodynamic compromise [1,2,3]. Intermediate Risk/ Submassive Pulmonary Embolism: Patients with sub-massive PE are hemodynamically stable, but they have right heart strain which makes higher cardiac enzymes, BNP and pro-BNP. They are at increased risk of decompensation and death [16]. Efficacy of Ultrasound Assisted Catheter-Directed Thrombolysis: The most common parameter to guide treatment is right ventricular–to–left ventricular (RV/LV) ratio, which is a validated parameter to predict short-term mortality in patient with PE [6,27,28]. The Ultrasound Assisted Catheter-Directed Thrombolysis for Acute Intermediate risk Pulmonary Embolism (ULTIMA) trial was the first RCT of UACDT [12]. When compared to catheter-directed therapy alone, the UACDT provides similar efficacy but reduced time thrombolytic infusion time and treatment-related complications [19]
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