Catheter-directed Thrombolysis In Patients Research Articles

Comment: Comparison of Large-Bore Thrombectomy With Catheter-Directed Thrombolysis for the Treatment of Pulmonary Embolism

Comparison of Large-Bore Thrombectomy With Catheter-Directed Thrombolysis for the Treatment of Pulmonary EmbolismJournal of the Society for Cardiovascular Angiography & InterventionsVol. 2Issue 1100453PreviewThere is significant debate on whether large-bore thrombectomy (LBT) or catheter-directed thrombolysis (CDT) is superior for the treatment of intermediate- and high-risk pulmonary embolism (PE) while employing an early invasive strategy through endovascular therapies. Full-Text PDF Open Access Feroze et al1Feroze R. Arora S. Tashtish N. et al.Comparison of large-bore thrombectomy with catheter-directed thrombolysis for the treatment of pulmonary embolism.J Soc Cardiovasc Angiogr Interv. 2023; 2100453Google Scholar retrospectively investigated important problem in contemporary pulmonary embolism (PE) practice by demonstrating that there was no difference in mortality and rehospitalization rates in patients with intermediate-to-high-risk (IHR) PE treated with large-bore thrombectomy compared with those in patients treated with catheter-directed thrombolysis (CDT). Furthermore, both treatment approaches for PE were similar concerning safety. Given the scarcity of randomized data in this setting and inconclusive evidence base regarding hard clinical end points,2Harvey J.J. Huang S. Uberoi R. Catheter-directed therapies for the treatment of high risk (massive) and intermediate risk (submassive) acute pulmonary embolism.Cochrane Database Syst Rev. 2022; 2022: CD013083Google Scholar,3Pietrasik A. Gąsecka A. Szarpak Ł. et al.Catheter-based therapies decrease mortality in patients with intermediate and high-risk pulmonary embolism: evidence from meta-analysis of 65,589 patients.Front Cardiovasc Med. 2022; 9861307Crossref Scopus (0) Google Scholar we would wish to complement the authors' findings with our own recently published retrospective data.4Giunio L. Lozo M. Borovac J.A. Bradaric A. Zanchi J. Miric D. Feasibility and safety of catheter-directed thrombolysis via superficial cubital vein for the treatment of acute massive and submassive pulmonary embolism.Postepy Kardiol Interwencyjnej. 2021; 17: 389-397Google Scholar In our cohort of patients presenting with IHR acute PE, we performed CDT through the superficial cubital vein using a standard pigtail catheter and administering alteplase locally. This method had a robust effect on hemodynamics because it significantly reduced SPAP, and mean PAP, and improved mean systemic perfusion pressure at 12 hours after intervention with a concomitant reduction in the Miller score and index, both reflecting the angiographic severity of pulmonary artery obstruction and perfusion. Of importance, the rates of adverse events, particularly bleeding, were low with 2 bleeding events of which only 1 required the transfusion of 1 unit of packed red blood cells. Furthermore, procedural success was 100% with no intracranial hemorrhage, access-site bleeding, or death events. However, no comparator was available in our study. Taken together, data from the study by Feroze et al1Feroze R. Arora S. Tashtish N. et al.Comparison of large-bore thrombectomy with catheter-directed thrombolysis for the treatment of pulmonary embolism.J Soc Cardiovasc Angiogr Interv. 2023; 2100453Google Scholar and our own suggest that CDT in patients with IHR acute PE is complementary to mechanical thrombectomy and is equally safe and effective procedure that can be successfully performed by cannulating either small or large veins by experienced operators. This is exquisitely important from the pharmacoeconomic standpoint. An option to use readily available catheters outside of dedicated thrombolytic or thrombectomy systems may provide significant economical savings, especially in resource-limited health care systems. Finally, both interventional approaches have a great potential to help a large proportion of patients with PE, and a transcubital access is also a feasible option in this scenario. However, as Feroze et al1Feroze R. Arora S. Tashtish N. et al.Comparison of large-bore thrombectomy with catheter-directed thrombolysis for the treatment of pulmonary embolism.J Soc Cardiovasc Angiogr Interv. 2023; 2100453Google Scholar rightly conclude, adequately powered randomized studies that would examine percutaneous thrombectomy versus CDT and OMT are needed to confirm the clear signal of benefit associated with catheter modalities. Finally, these observations should be put in the context with the recently published consensus statement on percutaneous therapies in acute PE, stipulating that CDT-based strategies should be considered in all cases of IHR acute PE in whom systemic thrombolysis is contraindicated or failed or there was a hemodynamic deterioration despite full therapeutic anticoagulation.5Pruszczyk P. Klok F.K. Kucher N. et al.Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions.EuroIntervention. 2022; 18: e623-e638Crossref Scopus (1) Google Scholar

Comparison of Balloon-Occluded Thrombolysis with Catheter-Directed Thrombolysis in Patients of Budd-Chiari Syndrome with Occluded Direct Intrahepatic Portosystemic Shunt.

Objectives Direct intrahepatic portosystemic shunt (DIPS) stent placement is an effective treatment for patients with Budd-Chiari syndrome (BCS); however, thrombotic occlusion of DIPS stent remains a cause of concern. The purpose of this study is to describe a novel technique of balloon-occluded-thrombolysis (BOT) for occluded DIPS stent, and compare it with the conventional catheter-directed-thrombolysis (CDT). Methods In this retrospective study, the hospital database was searched for BCS patients who underwent DIPS revision for thrombotic stent occlusion between January 2015 and February 2021. Patients were divided into CDT group and BOT group. The groups were compared for technical success, total dose of thrombolytic agent administered, duration of hospital stay, and primary assisted stent patency rates at 1- and 6-month follow-up. Results CDT was performed in 12 patients, whereas 21 patients underwent BOT. Complete recanalization was achieved in 66.7% (8 of 12) patients of CDT group as compared to 81% (17 of 21) patients of BOT group (nonsignificant difference, p = 0.420). BOT group had a short hospital stay (1.8 ± 0.7 vs. 3.5 ± 1.0 days) and required less dose of thrombolytic agent ([2.2 ± 0.4]x10 5 IU versus [8.3 ± 2.9]x10 5 IU of urokinase) as compared to the CDT group and both differences were statistically significant ( p < 0.001). Further, 6-month patency rate was higher in BOT group as compared to CDT group ( p = 0.024). Conclusion The novel BOT technique of DIPS revision allows longer contact time of thrombolytic agent with the thrombi within the occluded stent. This helps in achieving fast recanalization of thrombosed DIPS stent with a significantly less dose of thrombolytic agent required, thus reducing the risk of systemic complications associated with thrombolytic administration.

The Safety and Efficacy of Ultrasound-Accelerated Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk Pulmonary Embolism: Bo-NE-Experience.

Ultrasound-accelerated thrombolysis (USAT) is an advanced interventional therapy for patients with intermediate-high-risk pulmonary embolism (PE) who deteriorated on anticoagulation or for high-risk patients for whom systemic thrombolysis is contraindicated. The aim of this study is to investigate the safety and efficacy of this therapy with a focus on the improvement of vital signs and laboratory parameters. Seventy-nine patients with intermediate-high-risk PE were treated with USAT from August 2020 to November 2022. The therapy significantly decreased the mean RV/LV ratio from 1.2 ± 0.22 to 0.9 ± 0.2 (p < 0.001) as well as the mean PAPs from 48.6 ± 11 to 30.1 ± 9.0 mmHg (p < 0.001). The respiratory and heart rate decreased significantly (p < 0.001). Serum creatinine decreased significantly from 1.0 ± 0.35 to 0.9 ± 0.3 (p < 0.001). There were 12 access-associated complications, which could be treated conservatively. One patient had haemothorax after the therapy and had to be operated on. USAT is an effective therapy for patients with intermediate-high-risk PE, with favourable hemodynamic, clinical, and laboratory outcomes.

C-34 | Impact of Timing of Catheter-Directed Thrombolysis in Pulmonary Embolism on In-Hospital Outcomes

Catheter-Directed Thrombolysis (CDT) has emerged as an acceptable and safe modality in the treatment of intermediate to high-risk pulmonary embolism (PE). It is currently unknown whether in-hospital outcomes are affected by early (<48 hours) versus late (>48 hours) initiation of CDT from time of admission of patients with PE. The National Inpatient Sample database was queried from the years 2016-2019 to obtain our sample of PE admissions using appropriate ICD-10-CM codes. Those with concurrent acute limb ischemia, ischemic stroke, stenting or bypass procedures in the same admission were excluded. Our cohort was divided into those who underwent early or late intervention with CDT. Outcomes were measured using multivariate logistic regression and propensity score matching to obtain adjusted odds ratios (aOR). 27,435 patients received CDT, of which 22,650 underwent early intervention and 3,935 underwent late intervention. After propensity score matching, no differences in the likelihood of mortality (aOR 0.84, p=0.194) and vasopressor use (aOR 1.04, p=0.863) were found between the two interventions. The late intervention group had higher likelihood of concurrent need for systemic thrombolysis (aOR 1.66, p<0.01), blood transfusions (aOR 1.36, p<0.01), and intubation (aOR 1.31, p=0.01). Delaying CDT in patients with intermediate to high-risk PE led to a greater need for systemic thrombolysis, blood transfusion, and mechanical ventilation but did not lead to increase in-hospital mortality. Future randomized clinical trials should focus on the timing of CDT in PE to further elucidate its effects.

Short-Term Complications and Outcomes in Pharmaco-Mechanical Thrombolysis First and Catheter-Directed Thrombolysis First in Patients with Acute Lower Limb Ischemia

Pharmaco-mechanical thrombolysis (PMT) has emerged as a treatment option in patients with acute lower limb ischemia (ALI), especially Rutherford IIb (motor deficit) for rapid revascularization, but supportive data is scarce. The aim of the present study was to compare the effects of thrombolysis, complications, and outcomes of PMT first versus catheter-directed thrombolysis (CDT) first in a large cohort of patients with ALI. All endovascular thrombolytic/thrombectomy events in patients with ALI performed between January 1st, 2009, and December 31st, 2018 (n=347) were included. Successful thrombolysis/thrombectomy was defined as complete or partial lysis. Reasons for using PMT were described. Complications such as major bleeding, distal embolization, and new onset of renal impairment, and major amputation and mortality at 30days were compared between PMT (AngioJet) first and CDT first groups in a multivariable logistic regression model with adjustment for age, gender, atrial fibrillation, and Rutherford IIb. The most common reason for initial use of PMT was the need for rapid revascularization, and the most common reason for use of PMT after CDT was the insufficient effect of CDT. Presentation of Rutherford IIb ALI was more common in the PMT first group (36.2% vs. 22.5%, respectively, P=0.027). Among the 58 patients receiving PMT first, 36 (62.1%) were terminated within a single session of therapy without need of CDT. The median duration of thrombolysis was shorter (P<0.001) for the PMT first group (n=58) compared to the CDT first group (n=289) (4.0hr vs. 23.0hr, respectively). There was no significant difference in amount of tissue plasminogen activator given, successful thrombolysis/thrombectomy (86.2% and 84.8%), major bleeding (15.5% and 18.7%), distal embolization (25.9% and 16.6%), major amputation or mortality at 30-days (13.8% and 7.7%) in the PMT first compared to the CDT first group, respectively. The proportion of new onset of renal impairment was higher in the PMT first compared to the CDT first group (10.3% vs. 3.8%, respectively), and the increased odds (odds ratio 3.57, 95% confidence interval 1.22-10.41) were maintained in the adjusted model. In Rutherford IIb ALI, no difference in rate of successful thrombolysis/thrombectomy (76.2% and 73.8%), complications or 30-day outcomes was found between PMT first (n=21) and CDT (n=65) first group. PMT first appears to be a good treatment alternative to CDT in patients with ALI, including Rutherford IIb. The found renal function deterioration in the PMT first group needs to be evaluated in a prospective, preferably randomized trial.

Clinical outcomes of AngioJet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis.

The inferior vena cava filter is utilized worldwide to intercept thrombi and to reduce the risk of fatal pulmonary embolism (PE). However, filter-related thrombosis is a complication of filter implantation. Endovascular methods such as AngioJet rheolytic thrombectomy (ART) and catheter-directed thrombolysis (CDT) can treat filter-related caval thrombosis, but the clinical outcomes of both treatment modalities have not been determined. To compare the treatment outcomes of AngioJet rheolytic thrombectomy vs catheter-directed thrombolysis in patients with filter-related caval thrombosis. In this single-center retrospective study, 65 patients (34 males and 31 females; mean age: 59.0 ± 13.43 years) with intrafilter and inferior vena cava thrombosis were enrolled between January 2021 and August 2022. These patients were assigned to either the AngioJet group (n = 44) or the CDT group (n = 21). Clinical data and imaging information were collected. Evaluation measures included thrombus clearance rate, periprocedural complications, urokinase dosage, incidence of PE, limb circumference difference, length of stay, and filter removal rate. Technical success rates were 100% in the AngioJet and CDT groups. In the AngioJet group, grade II and grade III thrombus clearance was achieved in 26 (59.09%) and 14 (31.82%) patients, respectively. In the CDT group, grade II and grade III thrombus clearance was accomplished in 11 (52.38%) patients and 8 (38.10%) patients, respectively (P > 0.05).The peridiameter difference of the thigh was significantly reduced in patients from both groups after treatment (P < 0.05). The median dosage of urokinase was 0.08 (0.02, 0.25) million U in the AngioJet group and 1.50 (1.17, 1.83) million U in the CDT group (P < 0.05). Minor bleeding was shown in 4 (19.05%) patients in the CDT group, and when it was compared with that in the AngioJet group, the difference was statistically significant (P < 0.05). No major bleeding occurred. Seven (15.91%) patients in the AngioJet group had hemoglobinuria and 1 (4.76%) patient in the CDT group had bacteremia. There were 8 (18.18%) patients with PE in the AngioJet group and 4 (19.05%) patients in the CDT group before the intervention (P > 0.05). Computed tomography angiopulmonography (CTA) showed that PE was resolved after the intervention. New PE occurred in 4 (9.09%) patients in the AngioJet group and in 2 (9.52%) patients in the CDT group after theintervention (P > 0.05). These cases of PE were asymptomatic. The mean length of stay was longer in the CDT group (11.67 ± 5.34 d) than in the AngioJet group (10.64 ± 3.52 d) (P < 0.05). The filter was successfully retrieved in the first phase in 10 (47.62%) patients in the CDT group and in 15 (34.09%) patients in the AngioJet group (P > 0.05).Cumulative removal was accomplished in 17 (80.95%) out of 21 patients in the CDT group and in 42 (95.45%) out of 44 patients in the ART group (P > 0.05). The median indwelling time for patients with successful retrieval was 16 (13139) d in the CDT group and 59 (12231) d in the ART group (P > 0.05). Compared with catheter-directed thrombolysis, AngioJet rheolytic thrombectomy can achieve similar thrombus clearance effects, improve the filter retrieval rate, reduce the urokinase dosage and lower the risk of bleeding events in patients with filter-related caval thrombosis.

Midterm results of catheter-directed thrombolysis in patients with vasculitis with acute ischemia

Midterm results of catheter-directed thrombolysis in patients with vasculitis with acute ischemia

Clinical efficacy and safety of ultrasound-assisted thrombolysis vs. standard catheter-directed thrombolysis in patients with acute pulmonary embolism: A study level meta-analysis of clinical trials.

AimTo compare the clinical efficacy of ultrasound-assisted thrombolysis (USAT) vs. standard catheter-directed thrombolysis (SCDT) in patients with acute pulmonary embolism (aPE).MethodsThis study analyzed the clinical outcomes of patients with non-low-risk aPE who received USAT or SCDT. The primary outcomes were all-cause death, total bleeding, and major bleeding. Secondary outcomes included pulmonary thrombotic load score (Miller), improvement in right ventricular-to-left ventricular ratio (RV/LV), dose and duration of the thrombolytic drug tissue plasminogen activator (tPA), length of stay (LOS) in the ICU, and total LOS in the hospital.ResultsA total of seven articles and 451 patients were included in this study. 241 patients were in the USAT group and 210 patients were in the SCDT group. There were no significant differences in all-cause mortality, total bleeding, and major bleeding between the two groups. Miller scores for pulmonary thrombus also showed no difference between the two groups, but pulmonary artery systolic pressure (PASP) was lower in the SCDT group after-treatment. The reduction of RV/LV from baseline was more pronounced in the SCDT group than in the USAT group (OR: −0.14, 95%CI: −0.20 to 0.07, P < 0.0001, I2 = 0%). Total dose of tPA and duration of infusion in the USAT group were lower than those in the SCDT group, but there was no significant statistical difference. LOS in the ICU was similar between the two groups, while LOS in the hospital was lower in the SCDT group.ConclusionThis study did not detect any differences in all-cause mortality, total bleeding, and major bleeding between non-low-risk aPE patients treated with USAT or SCDT. Improvement in right ventricular function was better in the SCDT group, and hospital LOS was lower in the SCDT group.

Combined pharmacomechanical thrombectomy with selective catheter-directed thrombolysis in patients with acute proximal deep vein thrombosis.

Background The aim of this study was to evaluate the characteristics and the outcomes of combined percutaneous pharmacomechanical thrombectomy with selective catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis. Methods Between March 2018 and February 2020, a total of 37 patients (21 males, 16 females; mean age: 55±13.8 years; range, 21 to 79 years) with symptomatic acute iliofemoral vein thrombosis who underwent combined percutaneous pharmacomechanical thrombectomy and catheter-directed thrombolysis were retrospectively analyzed. All patients received a three-step therapy: (i) insertion of a temporary inferior vena cava filter, (ii) percutaneous pharmacomechanical thrombectomy via rotational mechanical thrombectomy device with an adjuvant 0.15 mg/kg recombinant tissue-type plasminogen activator alteplase, and (iii) catheter-directed thrombolysis with continuous 1 mg/h tissue-type plasminogen activator alteplase. Data including demographic characteristics of the patients, bleeding complications, technical success, and adjuvant angioplasty rates were analyzed. The Kaplan-Meier analysis was used to evaluate freedom from re-thrombosis at 3, 6, and 12 months of follow-up was calculated. Results The majority of the patients had left-sided (n=22, 59.4%) proximal deep vein thrombosis. Successful insertion of the inferior vena cava filter was achieved in 97.2% (n=36) of patients. The technical success rate was 89.1% (n=33). Adjuvant venous angioplasty was performed in four patients (10.8%) and no venous stents were used. No major bleeding was occurred, while minor bleeding was observed mostly in the form of hematuria (n=12, 32.4%). No mortality was observed. The 3, 6, and 12-month freedom from re-thrombosis rates were 96.3%, 92.6%, and 86.0%, respectively. Conclusion Combined percutaneous pharmacomechanical thrombectomy and catheter-directed thrombolysis seems to be an effective and safe treatment of the iliofemoral acute deep vein thrombosis with acceptable minor bleeding complications post-interventionally.

EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism

Background Percutaneous catheter-based ultrasound-assisted thrombolysis (UACDT) is recommended for patients with intermediate-high-risk or high-risk pulmonary embolism (PE) in whom systemic thrombolysis has failed or is contraindicated. Aim To evaluate the safety and efficiency of UACDT in patients with intermediate-high-risk or high-risk PE. Methods Between October 2017 and January 2020, we performed UACDT using the EkoSonic™ Endovascular System (EKOS™) in 51 patients (21 males, age 63 ± 18 years) with a sPESI of 1.3 ± 0.7. The EKOS™-catheter was implanted within 24 h after admission. Over 15 hours, 11.5 mg of alteplase was administered per catheter. We evaluated right ventricular stress and cardiac biomarkers before and after UACDT. Results 24 h post-UACDT, median RV/LV ratio decreased from 1.13 to 0.96 (p < 0.001) and the mean sPAP decreased from 47 ± 3 to 32 ± 2 mmHg + CVP (p < 0.0002). There were 6 major bleeding events resulting in transfusion. No stroke, myocardial infarction, right heart decompensation, or recurrent PE occurred. 31 patients (63%) were discharged without any signs of right ventricular stress. After at least 3 months, 73% of our patients did not show any signs of right ventricular dysfunction. The mean RV/LV ratio decreased to 0.75 ± 0.03 (p < 0.0001) in comparison with pre-UACDT, sPAP to 23 mmHg + CVP (p < 0.0001), and BNP to 40 pg/ml (p < 0.0001). Conclusions The treatment with UACDT reduced right heart stress during the first 24 hours and midterm in patients with intermediate-high-risk or high-risk PE at an acceptable rate of severe complications.

TCT-75 Comparison of Large-Bore Mechanical Thrombectomy and Catheter-Directed Thrombolysis in Patients With Acute Pulmonary Embolism: A Single-Center Experience

TCT-75 Comparison of Large-Bore Mechanical Thrombectomy and Catheter-Directed Thrombolysis in Patients With Acute Pulmonary Embolism: A Single-Center Experience

Efficacy of ultrasound-accelerated versus traditional catheter-directed thrombolysis in treatment of lower extremity deep venous thrombosis: A protocol for systematic review and meta-analysis.

Background:There is no meta-analysis or review in the literature to compare and evaluate the difference and effectiveness of ultrasonic-accelerated thrombolysis (UAT) and catheter directed thrombolysis (CDT) in lower extremity deep vein thrombosis (DVT) patients. Therefore, we conducted this protocol of systematic review and meta-analysis to evaluate the efficacy between UAT and CDT for patients with lower extremity DVT.Methods:We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols reporting guidelines to conduct this study. Reviewers will search the PubMed, Cochrane Library, Web of Science, and EMBASE online databases using the key phrases “deep venous thrombosis,” “thrombolysis,” and “ultrasound-accelerated” for all cohort studies published up to July 22, 2021. There is no restriction in the dates of publication or language in the search for the current review. The primary outcome is major bleeding. Secondary outcomes include health-related quality of life and complications such as recurrent venous thromboembolism, pulmonary embolism, in-stent thrombosis, and death. Review Manager software (v 5.4; Cochrane Collaboration) will be used for the meta-analysis. A P value of < .05 is considered to be statistically significant.Results:We hypothesized that these two methods would provide similar therapeutic benefits.OSF registration number:10.17605/OSF.IO/YZB3H.

Comparison of ultrasound-accelerated versus conventional catheter-directed thrombolysis for deep vein thrombosis: A systematic review and meta-analysis.

Recent in vitro and clinical studies have shown that ultrasound-accelerated catheter-directed thrombolysis (USACDT) can accelerate thrombolysis. Therefore, in this meta-analysis, we aimed to compare the efficacy and safety of USACDT with conventional catheter-directed thrombolysis in patients with deep vein thrombosis. A systematic search of the following electronic databases was performed from their dates of inception to 20 June 2020: MEDLINE, Scopus, Google Scholar, CINAHL, Cochrane Library, and EMBASE. All randomized controlled trials that directly compared the complications and efficacy of USACDT and conventional catheter-directed thrombolysis in patients with deep vein thrombosis were identified. The statistical analysis was performed using comprehensive meta-analysis software. Finally, 18 studies with a total of 597 participants were included in our meta-analysis according to the eligibility criteria. Pooled proportion of USACDT success in patients with deep vein thrombosis was 87.8% (18 studies; 95% CI: 83.1-91.3). Success rate was significantly higher in USACDT treatment than in conventional catheter-directed thrombolysis treatment (seven studies; OR: 2.96; 95% CI: 1.69-5.16; P < 0.01)). Although the mean infusion time was higher in catheter-directed thrombolysis treatment compared to USACDT treatment, this difference was not statistically significant (three studies; MD: -1.46; 95% CI: -3.25-0.32; P = 0.10). Moreover, pooled rate of complications was lower in USACDT than catheter-directed thrombolysis which was not statistically significant (seven studies; OR: 0.49; 95% CI: 0.13-1.76; P = 0.27). This meta-analysis revealed that USACDT significantly increased the success rate of thrombolysis compared to conventional catheter-directed thrombolysis. Furthermore, USACDT was associated with lower rate of complication and infusion time. Taken together, these findings confirm the superiority of this novel intervention over conventional catheter-directed thrombolysis in treatment of patients with deep vein thrombosis.

Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series

Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies.&#x0D; Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT.&#x0D; Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the oneyear study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented.&#x0D; Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases.&#x0D; Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory.

The efficacy of Pharmacomechanical catheter-directed thrombolysis in patients with concomitant deep vein thrombosis and pulmonary embolism: A retrospective analysis of 26 patients

The efficacy of Pharmacomechanical catheter-directed thrombolysis in patients with concomitant deep vein thrombosis and pulmonary embolism: A retrospective analysis of 26 patients

In-hospital outcomes of catheter-directed thrombolysis in patients with pulmonary embolism.

Catheter-directed treatment of acute pulmonary embolism (PE) is technically advancing. Recent guidelines acknowledge this treatment option for patients with overt or imminent haemodynamic decompensation, particularly when systemic thrombolysis is contraindicated. We investigated patients with PE who underwent catheter-directed thrombolysis (CDT) in the German nationwide inpatient cohort. Data from hospitalizations with PE (International Classification of Disease code I26) between 2005 and 2016 were collected by the Federal Office of Statistics in Germany. Patients with PE who underwent CDT (OPS 8-838.60 or OPS code 8-83b.j) were compared with patients receiving systemic thrombolysis (OPS code 8-020.8), and those without thrombolytic or other reperfusion treatment. The analysis was not prespecified; therefore, our findings can only be considered to be hypothesis generating. We analysed data from 978 094 hospitalized patients with PE. Of these, 41 903 (4.3%) patients received thrombolytic treatment [systemic thrombolysis in 4.2%, CDT in 0.1% (1175 patients)]. Among patients with shock, CDT was associated with lower in-hospital mortality compared to systemic thrombolysis [odds ratios (OR) 0.30 (95% 0.14-0.67); P = 0.003]. Intracranial bleeding occurred in 14 (1.2%) patients who received CDT. Among haemodynamically stable patients with right ventricular dysfunction (intermediate-risk PE), CDT also was associated with a lower risk of in-hospital mortality compared to systemic thrombolysis {OR 0.55 [95% confidence interval (CI) 0.40-0.75]; P < 0.001} or no thrombolytic treatment [0.45 (95% CI 0.33-0.62); P < 0.001]. In the German nationwide inpatient cohort, based on administrative data, CDT was associated with lower in-hospital mortality rates compared to systemic thrombolysis, but the overall rate of intracranial bleeding in patients who received CDT was not negligible. Prospective controlled data are urgently needed to determine the true value of this treatment option in acute PE.

In-hospital outcomes of catheter-directed thrombolysis in patients with pulmonary embolism

Abstract Background and purpose Catheter-directed treatment of acute pulmonary embolism (PE) is technically advancing. Recent guidelines acknowledge this treatment option for patients with overt or imminent haemodynamic decompensation, particularly when systemic thrombolysis is contraindicated or has failed. We investigated baseline characteristics and in-hospital outcomes of patients with PE who underwent catheter-directed thrombolysis (CDT) in the German nationwide inpatient cohort. Methods Data from hospitalizations with PE between 2005 and 2016 were collected by the Federal Office of Statistics (Statistisches Bundesamt) in Germany and included in this analysis. Patients with PE who underwent CDT were compared with patients receiving systemic thrombolysis, and those without thromboytic or other reperfusion treatment. Results We analyzed data from 978,094 hospitalized patients with PE. Of these, 41,903 (4.3%) patients received thrombolytic treatment (systemic thrombolysis in 4.2%, CDT in 0.1%). Among PE patients with shock, CDT was associated with lower in-hospital mortality compared to systemic thrombolysis (OR, 0.29, 95% CI 0.13–0.66, P=0.003). No intracranial bleeding occurred among PE patients with shock who received CDT. Among haemodynamically stable PE patients with right ventricular (RV) dysfunction (intermediate-risk PE), CDT also was associated with a lower risk of in-hospital mortality compared to systemic thrombolysis (OR, 0.52 [95% CI 0.38–0.70]; P&amp;lt;0.001) or no thrombolytic treatment (0.45 [95% CI 0.33–0.62]; P&amp;lt;0.001). Conclusion In the German nationwide inpatient cohort, CDT was associated with lower in-hospital mortality rates compared to systemic thrombolysis. Prospective controlled data are urgently needed to determine the true value of this treatment option in acute PE. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

USE OF CATHETER-DIRECTED THROMBOLYSIS TO TREAT ACUTE INTERMEDIATE-RISK PULMONARY EMBOLISM ASSOCIATED WITH BASELINE PULMONARY HYPERTENSION

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Catheter directed thrombolysis (CDL) is increasingly utilized as therapy for acute intermediate-risk pulmonary embolism (PE). Acute PE can lead to mild pulmonary hypertension (PHTN) but the role for CDL in patients with moderate to severe PHTN is uncertain. We investigate the impact of CDL on lowering PA pressure in PE patients with baseline hemodynamics suggestive of underlying PHTN. METHODS: 70 consecutive patients referred for CDL with acute intermediate-risk PE at two academic centers were included in this study. CT scan confirmed PE in all cases and intermediate risk was defined as having RV enlargement and/or troponin elevation without need for vasopressors. CDL was performed using a perfusion catheter with or without ultrasound and infusing t-PA at 1 mg/hour. Baseline hemodynamics were recorded at right heart catheterization, and post treatment pressures were measured through the perfusion catheter. RESULTS: The overall study population was 51% male, average age was 58 years, average presenting heart rate was 112 bpm, and average PESI score was 114. 38 patients had pre-procedure mean PA pressure of < 35 mmHg (designated as Group I) and 32 had pre-procedure mean PA pressure ≥ 35 mmHg (Group II). Admission vital signs, sex, and PESI scores were similar between groups. Group II was statistically younger (53 vs 62, p=0.01) and more likely to have had prior venous thromboembolic disease (37.5% vs 7.9%, p = 0.007). As defined, PA systolic pressure (36 mmHg vs 56 mmHg) and mean pressure (29 mmHg vs 44 mmHg) in Group I was lower than in Group II. In group II, 56% of patients had a mean PA of 35-44 mmHg and 44% of patients had a mean PA of ≥ 45 mmHg. The mean PAP decreased by 6 mmHg in Group I and by 8 mmHg in Group II compared to their pre-procedure values. Cardiac index increased significantly in both groups from 2.0 to 2.5 in group I, and from 1.8 to 2.2 L/min/m² in group II (p < 0.05 for both). After treatment, 60% of patients in group I had a mean PA pressure < 25 mmHg where only 3% in group II had achieved a normal PA pressure. The median dosage of t-PA was 12 mg in both groups. CONCLUSIONS: Treatment with CDL seems to benefit acute PE patients with mild as well as moderate-severe PHTN. Further prospective randomized studies are needed to determine the potential benefit of CDL over anticoagulation and the long-term impact on these patients. CLINICAL IMPLICATIONS: There has been reluctance to treat PE patients with higher PA pressures over concern that there was chronic PHTN present. Our data suggests that even in patients with a mean PAP ≥ 35 mmHg prior to treatment can derive benefit and lowering of PA pressures. DISCLOSURES: no disclosure on file for Lindsey Cilia; No relevant relationships by Matthew Herzig, source=Web Response No relevant relationships by Sameer Khandhar, source=Web Response No relevant relationships by Mili Mehta, source=Web Response No relevant relationships by Mili Mehta, source=Web Response Advisory Committee Member relationship with Actelion/Janssen Please note: $5001 - $20000 Added 05/20/2020 by Harold Palevsky, source=Web Response, value=Honoraria Advisory Committee Member relationship with United Therapeutics Please note: $5001 - $20000 Added 05/20/2020 by Harold Palevsky, source=Web Response, value=Honoraria Advisory Committee Member relationship with Acceleron Please note: $1001 - $5000 Added 05/20/2020 by Harold Palevsky, source=Web Response, value=Honoraria no disclosure on file for Catalin Toma

Outcomes with catheter‐directed thrombolysis compared with anticoagulation alone in patients with acute deep venous thrombosis

The authors aimed to investigate the benefits and risks of catheter-directed thrombolysis (CDT) in acute deep venous thrombosis (DVT). The role of CDT in the management of DVT is evolving. Data on CDT versus anticoagulation alone in acute DVT is sparse. We performed a systematic review and meta-analysis of published studies that compared CDT to anticoagulation alone in patients with acute DVT. We included 11 studies (four randomized control trials [RCTs] and seven observational studies) with a total of 8,737 patients. During hospital stay, patients who received CDT had higher odds of major bleeding (2.5% vs. 1.6%; OR 1.46, 95% CI [1.07, 1.98], p = .02), blood transfusion (10.8% vs. 6.2%; OR 1.8, 95% CI [1.52, 2.13], p < .001), and thromboembolism (15.5% vs. 10%; OR 1.67, 95% CI [1.47, 1.91], p < .001) compared with anticoagulation alone. At 6-month follow-up, patients who received CDT had higher venous patency (71.1% vs. 37.7%; OR 5.49, 95% CI [2.63, 11.5], p < .001) and lower postthrombotic syndrome (PTS; 27% vs. 40.7%; OR 0.44, 95% CI [0.22, 0.86], p = .02). During a mean follow-up duration of 30.5 ± 28 months, CDT group continued to have higher venous patency (79.6% vs. 71.8%; OR 3.79, 95% CI [1.54, 9.32], p = .004) and lower PTS (44.7% vs. 50.5%; OR 0.43, 95% CI [0.23, 0.78], p = .006), but no difference in thromboembolism. Compared with anticoagulation alone, CDT for patients with acute DVT was associated with a higher risk of complications, but a higher rate of venous patency and lower risk of postthrombotic syndrome at 2.5 years follow-up.

Role of Catheter-Directed Thrombolysis in Patients With Acute on Chronic Limb Ischemia Due to Buerger′S Disease with no Option Critical Limb Ischemia

Role of Catheter-Directed Thrombolysis in Patients With Acute on Chronic Limb Ischemia Due to Buerger′S Disease with no Option Critical Limb Ischemia