Catheter-directed Thrombolysis Group Research Articles

Cost-effectiveness analysis of anticoagulation, percutaneous mechanical thrombectomy, and catheter-directed thrombolysis treatments for acute lower extremity deep venous thrombosis.

There is a lack of health economics studies on the treatment of acute lower extremity deep venous thrombosis to measure the benefits to patients. The purpose of this study was to evaluate the cost-effectiveness of anticoagulation (AC), percutaneous mechanical thrombectomy (PMT), and catheter-directed thrombolysis (CDT). The above 3 methods were selected according to the patient's treatment wishes. Related complications, clinical effective, occurrence of post-thrombotic syndrome (PTS) after 2 years, and total hospitalization costs of patients between the patients in these 3 treatment groups were analyzed. In the cost-effectiveness analysis, costs were expressed in monetary terms and the effect was expressed as the effective rate of clinical treatment. In addition, we used sensitivity analyses to validate the results. The effective rate of clinical treatment for the AC, CDT, and PMT groups were 44.23%, 86.84%, and 92.59%, respectively. No serious complications occurred in any of the treated patients. There was no significant difference in the incidence of PTS among the 3 groups during the follow-up period. After 12 months, compared with the AC group, there were statistically significant differences in moderate-severe reduction in PMT group and CDT group separately. At 24 months, the incidence of moderate-severe disease in PMT group was significantly lower than that in CDT group. All 3 treatment methods have good safety. Compared with AC therapy alone, both PMT and CDT therapy resulted in a higher clinical efficacy rate, reduced the severity of PTS within 2 years, and reduced the cost of PTS. From the perspective of the cost-effectiveness ratio, within a certain range of treatment efficacy, AC therapy alone incurs the lowest cost per 1% improvement in therapeutic effect. The cost-effectiveness results show that if decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be lower than the ratio of incremental cost to effect, then AC therapy alone is chosen. If decision-makers consider the standard for improving the cure rate of lower limb deep vein thrombosis by 1% to be higher than the ratio of incremental cost to effect, then the choice is AC plus CDT treatment.

A Comparison of Postprocedural Hemoglobin in Catheter-Directed Thrombolysis versus Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism

PurposeTo compare changes in hemoglobin (HB) following catheter-directed thrombolysis (CDL) versus large-bore aspiration thrombectomy (LBAT) of acute pulmonary embolism (PE). Materials and MethodsA single-center retrospective review of patients with acute high- and intermediate-risk PE treated with CDL or LBAT between December 2009 and September 2023 was performed. The LBAT group was divided according to usage of an autotransfusion device (ATD). There were 166 patients in the CDL group (56 years ± 15). LBAT patients were treated without (LBAT, n = 58, 61 years ± 16) or with (LBATw, n = 47, 62 years ± 15) an ATD. Endpoints included change in HB between preprocedural and postprocedural measurements, the 7-day postprocedural nadir (low point), and adverse events (AEs). ResultsThe mean HB changes between preprocedural and postprocedural measurements in the CDL, LBAT, and LBATw groups were −1.3 g/dL ± 1.3, −1.6 g/dL ± 0.98, and −1.1 g/dL ± 0.9, respectively (P = .098). The mean HB changes to the 7-day postprocedural nadir in the CDL, LBAT, and LBATw groups were −1.7 g/dL (SD ± 1.4), −2.4 g/dL (SD ± 1.3), and −1.8 g/dL (SD ± 1.3), respectively (P = .008). The minor hemorrhagic AE rates were 3.6% in the CDL group, 12.1% in the LBAT group, and 14.9% in the LBATw group (P = .010). There was no significant difference in moderate (P = .079) and major (P = .529) hemorrhagic AEs between the groups. There were no procedure-related mortalities. ConclusionsThe use of LBAT without ATD resulted in a significant decrease in HB to the 7-day postprocedural nadir compared with CDL or LBAT with ATD. This did not translate into significantly higher transfusion rates or moderate or major hemorrhagic events. Findings suggest that the decision between CDL and LBAT should not be based solely on the expected blood loss consideration.

A systematic review and meta-analysis of the relative safety and efficacy of treating lower extremity deep vein thrombosis via pharmacomechanical thrombectomy and catheter-directed thrombolysis.

To evaluate the safety and efficacy of pharmacomechanical thrombectomy and catheter-directed thrombolysis (CDT) as approaches to treating deep venous thrombosis of lower extremities (LEDVT). The PubMed, Web of Science, Wanfang, Embase, Chinese Science and Technology Journal, Cochrane, and China National Knowledge Infrastructure (CNKI) databases were systematically searched for relevant articles published through October 2023, after which appropriate inclusion and exclusion criteria were used to screen out relevant articles. Review Manager 5.4.1 was used to extract key data from these studies, and pooled analyses were conducted based on mead difference (MD) or odds ratio (OR) values and corresponding 95% confidence interval (CI). Study quality was assessed with the Newcastle-Ottawa scale. This study has been registered at INPLASY.COM (No. INPLASY2023100075). In total, 31 relevant studies enrolling 2413 patients were included in this meta-analysis, with 1184 and 1229 patients in the AngioJet and CDT groups, respectively. These analyses revealed that the AngioJet group exhibited significantly higher rates of early postoperative deep vein patency (MD = 7.73, 95% CI (3.29, 12.17), p = .0006) and affected limb symptom improvement (MD = 6.31, 95% CI (1.82,10.80), p = .006) relative to the CDT group, whereas no differences in grade II or III thrombus clearance rates (OR = 1.30, 95% CI (0.95, 1.77), p = .10) or changes in thigh circumference before and after treatment (MD = 0.01, 95% CI (-0.80, 0.83), p = .97) were observed. The AngioJet group also exhibited lower urokinase doses (MD = -145.33, 95% CI (-164.28,126.38), p < .00001), shorter thrombolysis time (MD = -2.35, 95% CI(-2.80, -1.90), p < .00001), a less prolonged hospital stay (MD = -3.13, 95% CI(-3.81, -2.45), p < .00001), lower rates of PTS incidence (OR = 0.56, 95% CI(0.36, 0.88), p = .01), and reduced complication rates (OR = 0.51, 95% CI(0.31, 0.83), p = .0007). Studies published to date suggest that relative to CDT treatment, pharmacomechanical thrombectomy is associated with improved thrombus clearance, fewer complications, and lower complication rates in LEDVT patients, underscoring the safety and efficacy of this therapeutic strategy.

Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis.

Acute lower extremity deep venous thrombosis (LEDVT) is a common vascular emergency with significant morbidity risks, including post-thrombotic syndrome (PTS) and pulmonary embolism. Traditional treatments like catheter-directed thrombolysis (CDT) often result in variable success rates and complications. To investigate the therapeutic efficacy of percutaneous mechanical thrombus removal in acute LEDVT. A retrospective analysis was performed to examine 58 hospitalised patients with acute LEDVT between August 2019 and August 2022. The patients were categorised into the percutaneous mechanical thrombectomy (PMT) group (n = 24) and CDT group (n = 32). The follow-up, safety and treatment outcomes were compared between the two groups. The main observational indexes were venous patency score, thrombus removal effect, complications, hospitalisation duration and PTS. The venous patency score was 9.04 ± 1.40 in the PMT group and 8.81 ± 1.60 in the CDT group, and the thrombus clearance rate was 100% in both groups. The complication rate was 8.33% in the PMT group and 34.84% in the CDT group, and the difference was statistically significant (P < 0.05). The average hospitalisation duration was 6.54 ± 2.48 days in the PMT group and 8.14 ± 3.56 days in the CDT group. The incidence of PTS was lower in the PMT group than in the CDT group; however, the difference was not statistically significant (P < 0.05). Compared with CDT, treatment of LEDVT via PMT was associated with a better thrombus clearance rate, clinical therapeutic effect and PTS prevention function, but the difference was not statistically significant. Moreover, PMT was associated with a reduced urokinase dosage, shortened hospitalisation duration and reduced incidence of complications, such as infections and small haemorrhages. These results indicate that PMT has substantial beneficial effects in the treatment of LEDVT.

Pharmacomechanical Thrombectomy and Catheter-Directed Thrombolysis, with or without Iliac Vein Stenting, in the Treatment of Acute Iliofemoral Deep Vein Thrombosis.

This study aims to evaluate and compare the outcomes and clinical efficacy of pharmacomechanical thrombectomy (PMCT) plus catheter-directed thrombolysis (CDT) and PMCT combined with CDT and venous stenting in managing acute iliofemoral deep vein thrombosis (DVT), while also assessing the long-term safety and efficacy of these interventions. A retrospective case-control study spanning 3 years involved 112 patients presenting with acute symptomatic iliofemoral deep vein thrombosis (DVT), each with a symptom duration of less than 14 days. Patients were consecutively categorized into two groups based on individual clinical indications: PMCT + CDT vs. PMCT + CDT + venous stent. Statistical analyses were conducted to compare clinical features and outcomes between the two groups. Additionally, patients were followed up for 24 months post-treatment, during which quality of life (QoL) and severity of post-thrombotic syndrome (PTS) were analyzed. In this retrospective study, we analyzed a total of 112 consecutive patients, with 63 patients undergoing PMCT + CDT and 49 patients undergoing PMCT + CDT + venous stent. Between the two groups, regarding primary outcomes at 6 months, there was no difference in the observed cumulative patency rates, standing at 82.5% for PMCT + CDT and 81.6% for PMCT + CDT + stent. Survival analyses for primary, primary-assisted, and secondary patency yielded comparable results for PMCT + CDT, with p-values of 0.74, 0.58, and 0.72, respectively. The two-year patency rate was high in both groups (85.7% for PMCT + CDT vs. 83.7% for PMCT + CDT + stent). Additionally, during the follow-up period, there were no statistically significant differences observed in the incidence of PTS or the average Villalta score between the two groups. At 24 months post-intervention, the incidence of post-thrombotic syndrome (PTS) was 11.1% in the PMCT + CDT group and 22% in the PMCT + CDT + stent group (p = 0.381). Both treatment arms of the study groups experienced bleeding complications during the thrombolysis therapy; in the PMCT + CDT group, there were three cases of gastrointestinal bleeding, compared to two cases in the PMCT + CDT + stent group (p = 0.900). Additionally, there was one intracranial hemorrhage in the PMCT + CDT group and two in the PMCT + CDT + stent group. Pharmacomechanical thrombectomy (PMCT) combined with catheter-directed thrombolysis (CDT) therapy has shown significant efficacy in alleviating leg symptoms and reducing the occurrence of post-thrombotic syndrome (PTS), including the incidence of moderate-to-severe PTS. On the other hand, the utilization of PMCT + CDT + stent therapy, tailored to individual patients' clinical and venous conditions, may enhance long-term venous patency and lead to superior outcomes, including improved quality of life parameters.

Which one is the best in treating deep venous thrombosis —— percutaneous mechanical thrombectomy, catheter-directed thrombolysis or combination of them?

ObjectiveTo compare the treatment outcomes among percutaneous mechanical thrombectomy (PMT) with AngioJet, Catheter-directed thrombolysis (CDT), and a combination of both.MethodsOne hundred forty nine patients with acute or sub-acute iliac-femoral vein thrombosis accepting CDT and/or PMT were divided into three groups respectively: PMT group, CDT group, PMT + CDT group (PMT followed by CDT). The severity of thrombosis was evaluated by venographic scoring system. Technical success was defined as restored patent deep venous blood flow after CDT and/or PMT. Clinical follow-up were assessed by ultrasound or venography imaging. The primary endpoints were recurrence of DVT, and severity level of post-thrombotic syndrome (PTS) during the follow-up.ResultsTechnical success and immediate clinical improvements were achieved on all patients. The proportion of sub-acute DVT and the venographic scoring in PMT + CDT group were significantly higher than that in CDT group and PMT group (proportion of sub-acute DVT: p = 0.032 and p = 0.005, respectively; venographic scoring: p < 0.001, respectively). The proportion of May-Thurner Syndrome was lower in PMT group than that in CDT and PMT + CDT group (p = 0.026 and p = 0.005, respectively). The proportion of DVT recurrence/stent thrombosis was significantly higher in CDT group than that in PMT + CDT group (p = 0.04). The severity of PTS was the highest in CDT group ( χ2 = 14.459, p = 0.006) compared to PMT group (p = 0.029) and PMT + CDT group (p = 0.006).ConclusionPatients with sub-acute DVT, high SVS scoring and combined May-Thurner Syndrome were recommended to take PMT + CDT treatment and might have lower rate of DVT recurrence/stent thrombosis and severe PTS. Our study provided evidence detailing of PMT + CDT therapy.

Short-term efficacy of endovascular procedures for lower extremity thromboangiitis obliterans (Buerger’s disease)

ABSTRACT Purpose Although thrombolysis obliterans (TAO) has been recognized for more than a century, there is no optimal treatment for this disease. The aim of this report was to compare the short-term efficacies of catheter-directed thrombolysis (CDT), percutaneous transluminal angioplasty (PTA) and CDT+PTA in treating TAO disease. Method Consecutive patients with TAO treated at Ganzhou People’s Hospital between 2012 and 2022 were included in this retrospective study. According to the information provided in the medical records, endovascular procedures included CDT, PTA or CDT+PTA. One-year follow-up outcomes of the patients with TAO who underwent endovascular procedures were compared. The primary outcome was major adverse limb event (MALE) and the secondary outcomes were the technical success, complications, ABI at 1 week after surgery and minor amputation. Results Sixty-nine patients with TAO were assessed for inclusion in our single-center study from 2012 to 2022 and received endovascular procedures. Among them, 22 patients underwent CDT, 21 patients underwent PTA, and 26 patients underwent PTA+CDT. The one-year follow-up revealed significant differences in the MALE-free survival rates among the three groups, particularly between the CDT group and the PTA+CDT group (the hazard ratio (HR) for MALE-free survival was 0.173, 95% CI [0.050–0.599], p = 0.006). The technical success rates of the three groups were 63.6%, 90.5%, and 92.3%, respectively. There were differences in the ABI at one week after surgery among the three groups. Conclusions Endovascular procedures are effective for TAO in the short term. The effectiveness of CDT alone is suboptimal; combining CDT with PTA achieves the most favorable endovascular treatment outcome; while the effectiveness of PTA falls in between these two procedures.

A Retrospective Study Comparing Pharmacomechanical Thrombectomy with Catheter-Directed Thrombolysis for Acute Deep Venous Thrombosis

PurposeThis study aims to conduct a comparative analysis of the clinical efficacy and safety between pharmacomechanical thrombectomy (PMT) and catheter-directed thrombolysis (CDT) in the context of acute lower-extremity deep venous thrombosis (LEDVT). Materials and MethodsA retrospective review of our institution's patient database spanning from February 2011 to December 2019 was performed to identify cases of acute LEDVT. The patients were categorized into two distinct groups based on the thrombolytic interventions administered: the PMT group, specifically denoting PMT with AngioJet in our investigation, and the CDT group. Comprehensive data sets encompassing patient demographics, risk factors, procedural specifics, thrombolysis grading, and complications were collected. Subsequent follow-up evaluations at the two-year mark post-treatment included assessments of post-thrombotic syndrome (PTS) and the quality of life (QOL). ResultsAmong the 348 patients identified (mean age: 50.12 ± 15.87 years; 194 females), 200 underwent catheter-directed thrombolysis (CDT) during the early stage (2011 to 2017), while 148 received pharmacomechanical thrombectomy (PMT) between 2017 and 2019. Baseline data between the two groups exhibited no statistically significant differences. Thrombus scores significantly decreased in both cohorts post-therapy (each p < 0.001).Patients subjected to PMT demonstrated higher thrombolysis rates (77.35±9.44% vs 50.85±6.72%), reduced administration of the thrombolytic agent urokinase [20(20-20) vs 350(263-416), p < 0.001], larger limb circumference differences (above the knee: 6.03±1.76cm vs 4.51±1.82cm, p < 0.001; below the knee: 2.90±1.16cm vs 2.51±0.90cm, p < 0.001), and shorter lengths of stay (7.19±3.11 days vs 12.33±4.77 days, p < 0.001). However, the PMT group exhibited a higher decline in hemoglobin levels (13.41±10.59 g/L vs 10.88±11.41 g/L, p = 0.038) and an increase in creatinine levels [9.58(2.32-15.82) umol/L vs 4.53(2.87-6.08) umol/L, p < 0.001] compared to the CDT group. No statistically significant differences were observed in the numbers of balloon angioplasty, stent implantation (each p > 0.050), and minor and major complications between the two groups. At the 1-year follow-up, post-thrombotic syndrome (PTS) occurred in 13.51% of the PMT group compared to 26% of the CDT group (p = 0.025), with a higher incidence of moderate-severe PTS in the CDT group (8% vs 2.7%, p = 0.036). At the 2-year follow-up, PTS was observed in 16.2% of the PMT group and 31.5% in the CDT group, p = 0.004. Preoperative and postoperative D-values of SF-36 PCS and SF-36 MCS showed no statistically significant between-group differences. ConclusionIn our institutional experience, both pharmacomechanical thrombectomy (PMT) and catheter-directed thrombolysis (CDT) have proven to be effective and safe therapeutic approaches for managing acute lower-extremity deep venous thrombosis (LEDVT). PMT, in particular, demonstrated superior efficacy in achieving thrombosis resolution and mitigating the risk of post-thrombotic syndrome, affirming its role as a favorable intervention in this clinical context.

Comparison of In-Hospital Outcomes between Early and Late Catheter-Directed Thrombolysis in Acute Pulmonary Embolism: A Retrospective Observational Study.

The purpose of this study is to evaluate whether early initiation of catheter-directed thrombolysis (CDT) in patients presenting with acute pulmonary embolism is associated with improved in-hospital outcomes. A retrospective cohort was extracted from the 2016-2019 National Inpatient Sample database, consisting of 21,730 weighted admissions undergoing CDT acute PE. From the time of admission, the sample was divided into early (<48 h) and late interventions (>48 h). Outcomes were measured using regression analysis and propensity score matching. No significant differences in mortality, cardiac arrest, cardiogenic shock, or intracranial hemorrhage (p > 0.05) were found between the early and late CDT groups. Late CDT patients had a higher likelihood of receiving systemic thrombolysis (3.21 [2.18-4.74], p < 0.01), blood transfusion (1.84 [1.41-2.40], p < 0.01), intubation (1.33 [1.05-1.70], p = 0.02), discharge disposition to care facilities (1.32 [1.14-1.53], p < 0.01). and having acute kidney injury (1.42 [1.25-1.61], p < 0.01). Predictors of late intervention were older age, female sex, non-white ethnicity, non-teaching hospital admission, hospitals with higher bed sizes, and weekend admission (p < 0.01). This study represents a comprehensive evaluation of outcomes associated with the time interval for initiating CDT, revealing reduced morbidity with early intervention. Additionally, it identifies predictors associated with delayed CDT initiation. The broader ramifications of these findings, particularly in relation to hospital resource utilization and health disparities, warrant further exploration.

Ultrasound Combined With Continuous Microbubble Injection to Enhance Catheter-Directed Thrombolysis in Vitro and in Vivo.

To investigate the influence of microbubble perfusion mode on catheter-directed thrombolysis (CDT), we evaluated the effect of two different types of microbubble perfusion modes (continuous injection versus bolus injection) on the thrombolytic efficacy of CDT in vitro and further assessed the effect of continuous microbubble injection on CDT in vivo. In an in vitro experimental setup, 50 fresh bovine whole blood clots were randomized into five groups: ultrasound and continuous microbubble injection-enhanced CDT (US + cMB + CDT), ultrasound and bolus microbubble injection-enhanced CDT (US + bMB + CDT), US + CDT, US + cMB, and CDT. In a porcine femoral vein thrombosis model, 16 completely obstructive thrombi were randomly assigned to the CDT group and the US + cMB + CDT group, respectively. Thrombolysis rate, vascular recanalization rate, hematoxylin-eosin, and immunofluorescence staining were used to evaluate the thrombolytic effect in vitro and in vivo. In vitro, US + cMB + CDT group resulted in a significantly higher thrombolysis rate compared with the other four groups (P < .05). Meanwhile, this group also demonstrated a looser clot structure and more disrupted fibrin structures. In vivo, US + cMB + CDT contributed to a significantly higher vascular recanalization rate compared with CDT (87.50% versus 25.00%, P < .05). US + cMB + CDT was more effective than US + bMB + CDT in thrombolysis, and ultrasound combined with continuous microbubble injection could enhance the thrombolytic efficacy of CDT.

Large-bore aspiration thrombectomy versus catheter-directed thrombolysis for the treatment of pulmonary embolism: A retrospective case review from a community hospital

Objectives: This study aimed to assess acute outcomes following pulmonary embolism (PE) treatment with large-bore aspiration thrombectomy (LBAT) versus catheter-directed thrombolysis (CDT). Material and Methods: This single-center retrospective analysis included patients who received interventional therapy for acute PE from 2018 to 2022. The primary outcomes were changes in pre-procedural mean pulmonary artery pressure (PAP), heart rate (HR), oxygen saturation, and supplemental requirements following the procedure. Mean PAP was measured immediately post-procedure for LBAT patients and on postoperative day 1 (POD#1) for CDT patients. Results: A total of 48 patient cases were reviewed, 31 underwent LBAT and 17 underwent CDT. The majority of patients were female and most had intermediate-high-risk PE. No major bleeding events or device-related complications occurred. LBAT resulted in a significant decrease in average mean PAP immediately post-procedure (31.3 ± 9.0–21.4 ± 8.1 mmHg; P &lt; 0.001). On POD#1, CDT resulted in a significant decrease in mean PAP (31.7 ± 11.2–25.6 ± 7.9 mmHg; P = 0.005). The decrease in mean PAP was greater in the LBAT versus CDT group (P &lt; 0.05). Through POD#1, a similar reduction in average HR was observed between groups; however, a statistically significant reduction in HR was noted immediately post-procedure with LBAT and not with CDT. LBAT patients had a significant reduction in average supplemental oxygen requirements post-procedure. Conclusion: LBAT was associated with a greater reduction in mean PAP than CDT at an earlier post-procedural time point. LBAT may be advantageous over CDT due to rapid thrombus extraction; however, further studies with increased sample sizes are needed. Evidence-based medicine: Level of Evidence: Level 3, Local non-random sample.

Abstract 16030: Efficacy and Safety of Catheter Directed Thrombolysis in Intermediate to High-Risk Pulmonary Embolism: A Meta-Analysis of Randomized Trials

Background: Systemic anticoagulation (SA) is the standard treatment for acute pulmonary embolism (PE). The role of catheter directed thrombolysis (CDT) in addition to SA in intermediate-high risk PE remains unclear. Methods: Three randomized controlled trials comparing CDT+SA versus SA alone in intermediate-high risk PE were included in the analysis using databases including Embase, PubMed and Cochrane databases (inception June 01, 2023). The primary outcome was 90-day all-cause mortality. The secondary outcomes were major bleeding, number of patients with RV/LV ratio &gt;0.9 at 3 months, and vascular access complication. The outcomes were reported as relative risk (RR) with a 95% confidence interval (CI) using random effects model. Results: The analysis comprised of 179 patients with 88 in the CDT group and 79 in the SA group. There was no significant difference in 90-day all-cause mortality (RR: 0.19, 95% CI, 0.02-1.64, p=0.30) among both the groups. Similarly there was no significant difference in major bleeding (RR: 1.20, 95% CI, 0.03-46.18 p= 0.92), RV/LV ratio &gt;0.9 at 3 months (RR: 0.70, 95% CI, 0.41-1.21p=0.2) and vascular access complications (RR: 2.51, 95% CI, 0.44-14.35 p= 0.30). Conclusions: Our study found no significant advantage of CDT+SA versus SA alone in patients with intermediate-high risk PE. Given the scarcity of randomized data, we emphasize the need for a large-scale randomized trial to investigate the long-term effects of CDT in this population.

A comparison of the efficacy and safety between anticoagulation alone and combined with catheter-directed thrombolysis for treatment of pulmonary embolism on outcome: A systematic review and meta-analysis.

Catheter-directed thrombolysis (CDT) is one of the newest treatment options for submassive pulmonary embolism (sPE). This study will compare the efficacy and safety of catheter-directed thrombolysis (CDT) combine with anticoagulation versus anticoagulation alone (AC) in patients with PE. A database search was conducted using PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov for trials that compared CDT with AC in patients with pulmonary embolism. The primary outcomes was1-year mortality. The secondary outcomes were in-hospital, 30days, 90days mortality, in-hospital major and minor bleeding (Thrombolysis in Myocardial Infarction (TIMI) classification), length of hospital stay (LOS), reduction of pulmonary arterial systolic pressure (PASP) and RV/LV diameter ratio. A total of 16 articles (3 RCTs and 13 non-RCTs) and 10595 patients were included in this study. 2237 patients were in the CDT group and 8358 patients were in the AC group. CDT group was associated with significantly lower in-hospital mortality (2.1% vs 6.2%,OR:0.36, 95%CI:0.26-0.51, p < .00001,I2 = 0%), 30days mortality (3.1% vs 8.6%,OR:0.39,95%CI:0.23-0.66, p = .0005, I2 = 0%), 90days mortality (3.8% vs 7.7%,OR:0.49,95%CI:0.29-0.80,p = .005,I2 = 7%), 1-year mortality (6.1% vs 11%, OR:0.51, 95%CI:0.35-0.76, p = .0008,I2 = 36%) compared to AC group, especially in ultrasound-assisted thrombolysis (USAT) subgroup. There were no differences on major bleeding between two groups (1.8% vs 2.2%, OR:1.10, 95%CI:0.61-1.98, p = .75, I2 = 0%). Minor bleeding was significantly higher in CDT group than AC group (6.2% vs 3.8%, OR:1.93,95%CI:1.27-2.94.66, p = .002, I2 = 1%). CDT group significantly reduced PASP (WMD:11.90,95%CI:6.45-17.35, p < .0001, I2 = 72%) and RV/LV (WMD:0.17,95%CI:0.04-0.30, p = .009, I2 = 69%) rapidly than AC group after treatment. LOS was similar between two groups (WMD:0.02,95%CI: -0.68-0.73, p = .95, I2 = 51%). Results thus confirmed that CDT reduced in-hospital, 30days, 90days and 1-year all-cause mortality in patients with sPE compared to AC, particularly in USAT subgroup. Nonetheless, CDT group was associated with a higher risk of minor bleeding.

AngioJet rheolytic thrombectomy coupled with dose-reduced rt-PA for massive inferior vena cava filter-related thrombosis: A single-center retrospective study

ObjectiveTo evaluate the efficacy and safety of AngioJet rheolytic thrombectomy (ART) coupled with dose-reduced rt-PA, compared to catheter-directed thrombolysis (CDT) alone, for the treatment of massive inferior vena cava filter (IVCF)-related thrombosis. MethodsWe conducted a retrospective analysis of 40 patients who received either ART or CDT alone as the first-line endovascular therapy (ET) between January, 2016 and September, 2022. The data on demographics, clinical characteristics, technical success, clinical success, complications, and early follow-up were reviewed. ResultsOf the 40 included patients, 24 received ART and 16 received CDT alone. The demographics, presentation, lesion characteristics, comorbidities and risk factors were comparable (all p > .05). Technical success rates were 100% in both groups. The total CDT time and infusion agent dosage were lower in the ART group than those in the CDT group (both p < .05). At the end of CDT, clinical success was 81.8% in the ART group, which was slightly higher than that of 70.8% in the CDT group (p > .05). At the 6-month follow-up, the incidences of recurrent thrombosis in the two groups were 6.9% and 15.8%, respectively, and the incidence of post-thrombotic syndrome was 10.3% and 21.1%, respectively. However, these differences were not statistically significant (p > .05). No major complications were noted in either group, ART seemed to have slightly higher risk of transient macroscopic hemoglobinuria and recoverable acute kidney injury, but with a lower minor bleeding incidence when compared with CDT alone (4.2 vs. 31.3%, p < .05). ConclusionsART or CDT alone as the first-line ET for IVCF-related thrombosis has comparable outcomes but with different adverse event profiles. Both modalities are safe and effective in patients with massive IVCF-related thrombosis.

Predictors of chronic thromboembolic pulmonary hypertension in patients with submassive pulmonary embolism treated with catheter-directed thrombolysis versus anticoagulation alone: A secondary analysis of the SUNSET sPE trial

ObjectiveChronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary embolism (PE) is a morbid complication with suboptimal treatment. We aimed to evaluate the biomarker profile and functional outcomes in patients with submassive PE (sPE) treated with catheter-directed thrombolysis (CDT) compared with anticoagulation alone (ACA). We performed a secondary biomarker and survey analysis of the SUNSET sPE (standard vs ultrasound-assisted catheter thrombolysis for submassive pulmonary embolism) randomized trial comparing standard CDT to ultrasound-assisted thrombolysis in patients with sPE. MethodsAs a part of the SUNSET sPE study, patients who did not receive an intervention were enrolled in the medical (ACA) arm. The biomarkers associated with CTEPH in the literature (ie, CCL2, CXCL10, PTX3, GDF-15, RAGE, BCA-1, TFPI) were collected and measured using a multiplex assay at diagnosis, discharge, and 3-month follow-up. Patients underwent a 6-minute walk test and answered quality-of-life questionnaires (pulmonary embolism quality of life; University of California, San Diego, shortness of breath questionnaire; 36-item short-form survey) at 3 months after diagnosis. Comparisons were made using the Student t test. Nonparametric tests were used when the distributions were not normal. Significance was set at P ≤ .05. ResultsA total of 72 patients (age, 56 ± 15 years; 40.3% women) were included in the present analysis. Of these 72 patients, 53 underwent CDT and 19 were included in the ACA arm. The baseline right ventricle/left ventricle ratios were similar between the two groups (CST, 1.8; ACA, 1.7). The survival and complication rates were similar between the two groups. At discharge, CXCL10 (768.9 ± 148.6 pg/mL vs 3032.0 ± 1201.0 pg/mL; P = .018) and PTX3 (3203.5 ± 1298.0 pg/mL vs 12,716.2 ± 6961.5 pg/mL; P = .029) were lower in the CDT group and displayed a quicker return to baseline than in the ACA group. This trend, although not significant, was also seen with the other biomarkers. At 3 months, the 6-minute walking distance and quality-of-life scores were similar between both groups. ConclusionsIn patients with sPE, the biomarkers of CTEPH were lower with CDT compared with ACA. At 3 months, both groups demonstrated similar biomarker levels, 6-minute walking distances, and quality-of-life scores.

Clinical Comparison of the Efficacy of Systemic Thrombolysis,Catheter-Directed Thrombolysis,and AngioJet Percutaneous Mechanical Thrombectomy in Acute Lower Extremity Deep Venous Thrombosis

Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.

Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a meta-analysis.

To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) versus systemic thrombolysis (ST) in the treatment of pulmonary embolism (PE). The Cochrane Library, PubMed, and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020, and meta-analysis was performed by STATA software (version 15.1). Using standardized data-collection forms, the authors screened the studies and independently extracted data, and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort studies. Cohort studies that examined the following results were included in the current study: in-hospital mortality, all-cause bleeding rate, gastrointestinal bleeding rate, intracranial hemorrhage rate, the incidence of shock, and hospital length of stay. A total of eight articles, with 13,242 participants, involving 3962 participants in the CDT group and 9280 participants in the ST group were included. CDT compared with ST in the treatment of PE can significantly affect in-hospital mortality rate [odds ratio (OR) = 0.41, 95% CI: 0.30-0.56, P < 0.05], all-cause bleeding rate (OR = 1.20, 95% CI: 1.04-1.39, P = 0.012), gastrointestinal bleeding rate (OR = 1.43, 95% CI: 1.13-1.81, P = 0.003), the incidence of shock (OR = 0.46, 95% CI: 0.37-0.57, P < 0.05), and hospital length of stay [standard mean difference (SMD) = 0.16, 95% CI: 0.07-0.25, P < 0.05]. However, there was no significant effect on intracranial hemorrhage rate in patients with PE (OR = 0.70, 95% CI: 0.47-1.03, P = 0.070). CDT is a viable alternative to ST in the treatment of PE, as it can significantly reduce in-hospital mortality rate, all-cause bleeding rate, gastrointestinal bleeding rate, and incidence of shock. However, CDT may prolong hospital length of stay to a certain extent. Further research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.

Reperfusion therapies in elderly and frail patients with pulmonary embolism: a nationwide inpatient sample analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Although mortality rates have decreased over the last two decades especially for older ages, among patients with PE, age is considered as a significant risk factor for morbidity and mortality. Purpose To assess the contemporary rates in the use of reperfusion therapies for the management of elderly and frail hospitalized patients with PE and specifically investigate their effect on safety outcomes. Methods The Nationwide Inpatients Sample (NIS) of years 2016-2018 was accessed to select all hospitalizations of elderly (≥65 years) patients with acute PE as a main discharge diagnosis code or PE as a second-listed diagnosis code following a main discharge diagnosis code for deep vein thrombosis or respiratory failure. We defined frail patients with the use of the Johns Hopkins Adjusted Clinical Groups frailty defining diagnoses indicator, which is an instrument based on ten clusters of frailty defining diagnoses (i.e., malnutrition, dementia, impaired vision, decubitus ulcer, urinary incontinence, weight loss, social support needs, difficulty in walking, and falls). Multivariate logistic regression was used to calculate odds ratios of in-hospital overall and major bleeding among patients who received at least one reperfusion therapy and make two comparisons: (i) systemic thrombolysis (ST) vs catheter-directed thrombolysis (CDT), and (ii) catheter-based thrombectomy (CBT) vs surgical embolectomy (SE). Results A total of 310,145 elderly hospitalizations with a primary PE diagnosis were estimated in 2016-2018, of which 66,745 (21.5%) were frail. Reperfusion therapies were used in 7.0% of all primary PE hospitalizations of elderly people without frailty (35.9% among high-risk patients), while in 4.4% with frailty (24.7% among high-risk patients) (Figure 1). In elderly, CDT was not associated with reduced overall in-hospital bleeding compared to ST (13.6% vs 17.9%, odds ratio [OR] 0.88, 95% confidence interval [CI] 0.73-1.05), but associated with reduced major bleeding (4.9% vs 8.9%, OR 0.68, 95%CI 0.51-0.90) (Figure 2A). Among frail patients, overall bleeding events were significantly fewer in the CDT group compared to ST (14.4% vs 27.6%, OR 0.49, 95%CI 0.31-0.78), although there was no difference in major bleeding (8.4% vs 11.2%, OR 0.85, 95%CI 0.46-1.59) (Figure 2A). Among all hospitalizations of elderly patients who received either CBT or SE, there was difference in overall bleeding events (20% vs 51.7%, OR 0.28, 95%CI 0.17-0.46), but not in major bleeding (8.2% vs 15.7%, OR 0.58, 95%CI 0.27-1.23) (Figure 2B). Among the subgroup of frail patients CBT tended to result in reduced overall bleeding (24.7% vs 45.5% for SE) and major bleeding rates (12.3% vs 27.3%), although without statistical significance (Figure 2B). Conclusion(s) Catheter-directed therapies appear to have a favorable safety profile over ST and SE and may offer an alternative for the high-risk PE management of elderly patients.

Ten-year Experience of Surgical Management of Paget-Schroetter Syndrome

Paget-Schroetter syndrome (PSS) or effort-induced thrombosis, is an acute (< 14 days) venous thrombosis of the axillosubclavian vein. Early catheter-directed thrombolysis is required, to improve patency rate and avoid post thrombotic syndrome. This study aimed to report the management of Paget-Schroetter syndrome in our center across 10 years and to compare it to the established guidelines. Some of the selected patients were treated with catheter-directed thrombolysis (CDT) if the diagnosis of acute vein thrombosis was established 6 weeks after the appearance of the first symptoms and if a vascular surgeon was involved in the care and management of the patient. Patients underwent first rib removal 6 weeks after the CDT. Some patients with primary upper-limb venous thrombosis were not immediately referred to a vascular surgeon after the initial diagnosis. They were instead discharged home with the prescription of oral anticoagulation therapy (OAT) alone for at least 3 months. Between 2010 and 2020, 426 first rib removal procedures were performed for 338 patients with TOS at our center. Among them, eighteen (4.2%) patients with PSS were identified. Five (27.8%) patients underwent catheter directed thrombolysis. Median duration between first symptoms and thrombolysis was 10 days (range 1 to 32). Thirteen (72.2%) patients were discharged home with oral anticoagulation therapy alone and referred to a vascular surgeon with a median time of 365 days (range 8 to 6422) for thoracic outlet syndrome diagnosis. Post-thrombotic syndrome was noticed in 5 (38%) patients in the OAT group and 1 (20%) patient in the CDT group. Despite the guidelines being in favor of early CDT in Paget-Schroetter syndrome, most patients are discharged home o, oral anticoagulation therapy alone. The study findings demonstrate that better information about this specific complication must be provided to the concerned practitioners who are likely to encounter such patients.

Discussion on operation: To compare the curative effect of PMT and CDT in the treatment of middle and high risk stratified APE and the clinical application value of serum BNP, TnI and plasma DFR levelse.

To compare the efficacy of Percutaneous mechanical thrombectomy (PMT) and Catheter directed thrombolysis (CDT) in the treatment of patients with moderate and high-risk ape and explore the clinical application value of biomarkers in the treatment of moderate and high-risk ape. A total of 84 patients with ape were selected from the Department of vascular surgery of the Second Affiliated Hospital of Shandong First Medical University and the Department of vascular surgery of Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine. According to the relevant guidelines, they were divided into high-risk and medium-risk groups, including PMT groups (35 cases) and CDT groups (49 cases). To detect the changes of serum B-type brain natriuretic peptide (BNP),Troponin I (TnI) and plasma D-dimer/fibrinogen ratio (DFR) levels in different risk stratification before and after PMT and CDT, the correlation and diagnostic value of each index, and compare the thrombus clearance rate, pulmonary artery pressure, average dosage of urokinase, effective thrombolytic time, average hospitalization time and complications of PMT and CDT. Under different treatment methods and risk stratification, there was no statistically significant difference in the clinical data of patients at general baseline;The preoperative BNP, TnI and DFR levels of PMT and CDT in the middle and high risk stratification were significantly lower than those in the other groups (P < 0.005),Compared with the CDT group, PMT has significantly better therapeutic effect on ape than the CDT group in terms of thrombus clearance rate, pulmonary artery pressure, average dosage of urokinase, effective thrombolytic time and average hospitalization time (P < 0.05),meanwhile,there was no significant difference in postoperative complications between the two groups (P < 0.05). After half a year of follow-up, the levels of BNP, TnI and DFR in the cured group were significantly lower than those in the effective group and the ineffective group. The areas under the curve of serum BNP, TnI and plasma DFR were 0.91, 0.87 and 0.93 and the area under the curve DFR has higher diagnostic efficiency than BNP and TnI, while the sensitivity and specificity of TnI are significantly higher than BNP and DFR. Serum BNP, TnI and plasma DFR levels can reflect the risk stratification and better clinical diagnostic value of ape,PMT and CDT are used to treat high-risk ape. For hospitals with medical conditions, PMT is more worthy of clinical recommendation.