EkoSonic Endovascular System Research Articles

Initiating and imaging cavitation from infused echo contrast agents through the EkoSonic catheter

Ultrasound-enhanced delivery of therapeutic-loaded echogenic liposomes is under development for vascular applications using the EkoSonic Endovascular System. In this study, fibrin-targeted echogenic liposomes loaded with an anti-inflammatory agent were characterized before and after infusion through an EkoSonic catheter. Cavitation activity was nucleated by Definity or fibrin-targeted, drug-loaded echogenic liposomes infused and insonified with EkoSonic catheters. Passive cavitation imaging was used to quantify and map bubble activity in a flow phantom mimicking porcine arterial flow. Cavitation was sustained during 3-min infusions of Definity or echogenic liposomes along the distal 6 cm treatment zone of the catheter. Though the EkoSonic catheter was not designed specifically for cavitation nucleation, infusion of drug-loaded echogenic liposomes can be employed to trigger and sustain bubble activity for enhanced intravascular drug delivery.

Utilization of EKOS in Patients With Pulmonary Embolism.

Objective: Current guidelines recommend utilization of catheter-directed thrombolysis systems for management of patients with submassive pulmonary embolism (PE) who have relative contraindications to systemic thrombolysis. Evidence from previous trials have demonstrated the short-term efficacy and safety of one of these systems, the EkoSonic Endovascular System (EKOS). The objective of this study was to evaluate the long-term efficacy and safety of EKOS in submassive PE. Methods: This single-center, retrospective study evaluated subjects ≥18 years old with submassive PE and baseline right ventricular to left ventricular (RV/LV) diameter ratio ≥1. The primary outcome evaluated change in RV/LV diameter ratio from baseline to first follow-up. The secondary outcomes evaluated need for further intervention after EKOS, major bleeding within 72 hours and 6 months, all-cause mortality at 6 months, and all-cause 30-day readmission rate. Results: Overall, 41 subjects received EKOS for submassive PE. Of the 26 subjects evaluated for the primary outcome, the RV/LV diameter ratio decreased by an average of 0.56 (P < 0.05). Of the 41 subjects evaluated for the secondary outcomes, 1 subject required pulmonary embolectomy after EKOS intervention, 1 major bleed occurred within 72 hours, 1 major bleed occurred within 6 months, 1 subject died within 6 months, and 3 subjects were readmitted within 30 days. Conclusions: Intervention with EKOS further reduced right heart strain and resulted in few complications compared with previous trials providing evidence that EKOS is effective and safe long-term for management of submassive PE. Use should be considered in patients with relative contraindications to systemic thrombolytic therapy.

Determination of Ekosonic Endovascular System Treatment According to Patient Characteristics in High-Risk Pulmonary Embolism Patients

Determination of Ekosonic Endovascular System Treatment According to Patient Characteristics in High-Risk Pulmonary Embolism Patients

Response Team Management of Acute Serious Pulmonary Embolism.

Response Team Management of Acute Serious Pulmonary Embolism.

Novel Pharmacomechanical Thrombolysis for Treating Intermediate-Risk Acute Pulmonary Embolism: The Bashir Endovascular Catheter.

Novel Pharmacomechanical Thrombolysis for Treating Intermediate-Risk Acute Pulmonary Embolism: The Bashir Endovascular Catheter.

Stability of alteplase for ultrasound-facilitated catheter-directed thrombolysis

AbstractUltrasound-facilitated catheter-directed thrombolysis is used with low-dose alteplase to treat pulmonary embolism. This reduces the risk of bleeding that accompanies systemic administration of higher alteplase doses. Some studies suggest that alteplase given over 2 to 6 hours is safe and effective, but there are few data to support the stability of alteplase under these conditions. Therefore, we undertook this in vitro study to determine the duration of alteplase stability. Alteplase was prepared in solutions of 8 mg in 100 mL, 6 mg in 150 mL, and 8 mg in 200 mL. Solutions were administered through the EkoSonic Endovascular System (with and without ultrasound) to simulate administration over 2, 4, and 6 hours. Alteplase was assessed with reversed-phase high-performance liquid chromatography (RP-HPLC). Assays were performed at time 0 and at 30-minute intervals during simulated infusion. An enzyme-linked immunosorbent assay was used to measure alteplase concentrations at time 0 and at 15-minute intervals during simulated infusion. By using RP-HPLC in the absence of ultrasound, the alteplase concentration remained within 1% of the original concentration through 120, 240, and 360 minutes of infusion. By using RP-HPLC for measurement, alteplase in the presence of ultrasound degraded steadily over time to ∼90% of its original amount in 120 minutes, ∼80% in 240 minutes, and ∼70% in 360 minutes. The remaining alteplase was available for enzymatic activity. Alteplase solutions of 0.04 and 0.08 mg/mL degraded steadily over time during simulated ultrasound-facilitated catheter-directed administration. Alteplase that did not degrade remained available for enzymatic activity.

Ultrasound-assisted catheter directed thrombolysis for pulmonary embolus during extracorporeal membrane oxygenation.

Acute pulmonary embolism (PE) is the third most common cause of cardiovascular death. For patients who are hemodynamically unstable, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support has been shown to provide hemodynamic stability, and allow time for definitive treatment and recovery. Ultrasound-assisted catheter directed thrombolysis (USAT) has the potential to be a safe adjunct and expedite right ventricular (RV) recovery for patients requiring VA-ECMO for PE. A review of all VA-ECMO patients from January 2017 to September 2019 was performed. A total of 49 of these patients were cannulated due to a PE. USAT therapy was used as an adjunct in 6 (12%) of these patients. These 6 patients were given standardized USAT therapy with EKOs catheters at 1 mg/h of tissue plasminogen activator with an unfractionated heparin infusion for additional systemic anticoagulation. Outcomes, including in-hospital death, 90-day survival, RV recovery, and complications, were examined in the cohort of patients that received USAT as an adjunct to ECMO. Median age was 54 years old. Five of the six patients presented with a massive PE and had a PE severity score of Class V. One patient presented with a submassive PE with a Bova score of 2, but was cannulated to VA-ECMO in the setting of worsening RV function. All patients demonstrated recovery of RV function, were free from in-hospital death, and were alive at 90-day follow-up. Ekosonic endovascular system therapy may be a safe and feasible adjunct for patients on VA-ECMO for PE, and allow for survival with RV recovery with minimal complications.

Evidence-Based Management of a Patient With an EKOS Catheter.

Q: What are the evidence-based recommendations for nursing management of a patient with an EKOS catheter?A: Sara Knippa, MS, RN, ACCNS-AG, CCRN, PCCN, and Shannon Vernon, BSN, RN, CCRN, reply:Catheter-directed thrombolysis (CDT) is a targeted alternative to systemic thrombolysis. It can be used for patients experiencing thrombotic problems such as deep vein thrombosis, pulmonary embolism, and peripheral arterial occlusion. In CDT, an infusion catheter is inserted into the artery or vein through a sheath and guided to the site of the thrombus. A thrombolytic agent, often alteplase, is continually infused through the catheter directly to the clot for a particular amount of time.1Therapy using an EKOS catheter, as part of the EkoSonic Endovascular System (Boston Scientific), takes CDT a step further by adding intravessel ultrasound. The EkoSonic Endovascular System (EKOS) consists of a specialized catheter (see Figure) and a control unit. The catheter delivers small ultrasound waves, which assist the thrombolytic medication to dissolve the clot.2 The technique of applying ultrasound waves while administering a thrombolytic medication is called ultrasound-assisted or ultrasound-accelerated thrombolysis (USAT); the EKOS equipment is prominently used for USAT.1Some question remains regarding the benefit of USAT compared with that of CDT in various clinical situations. The intended benefit of the ultrasound waves is to dissolve the clot faster or to require a lower dose of the thrombolytic drug, thereby decreasing the risk of bleeding and other complications. Most USAT systems, however, are more expensive than CDT. Does the extra expense translate into improved clinical outcomes? Some initial support exists for the clinical benefit of USAT in patients with arterial thromboembolic disease3 and deep vein thrombosis,4 but more evidence is needed. Recent studies suggest that CDT and USAT are not significantly different in patients with pulmonary embolism.5,6 Until definitive data are available, nurses may use both USAT and CDT in clinical practice.Very little definitive information is available to provide an evidence-based approach to nursing care for patients receiving thrombolytic therapy in conjunction with USAT.1 Therefore, from a nursing perspective, the best approach is to understand how a USAT system functions and how to troubleshoot any problems, and to focus on the most common complications that occur with any thrombolytic drug. These steps will allow nurses to appropriately target assessments and interventions.Nurses should be familiar with the USAT system that their organization uses. The ultrasound therapy must be running in order for the system to be effective. For example, with the EKOS system, the ultrasound should not run without infusions instilling through both lumens of the catheter (see Figure): the thrombolytic agent infuses through the drug lumen, and normal or heparinized saline infuses through the coolant lumen. The thrombolytic infusion does not stop, regardless of the status of the ultrasound. The ultrasound can be paused when necessary (eg, for Doppler assessment, during ultrasound diagnostic tests), but otherwise the nurse should verify that the ultrasound is running at all times; to do so, one can look for the blinking yellow light on the console.7,8Complications may stem from vascular access, thrombolytic drug administration, and contrast used for imaging. The EKOS catheter and sheath can be removed at the bedside or in a procedural area. Staff who can remove the catheter and sheath should receive specific training in this process. In addition, an inferior vena cava filter may need to be placed after removal of the catheter and sheath in order to reduce the patient’s risk of pulmonary embolism.7Manufacturer recommendations provide a stable starting point for the development of facility-specific guidelines for the care of patients receiving USAT. Additional strategies that may be helpful when evidence-based guidelines are not available include reaching out to other facilities who are using the equipment, reaching out to national organizations, and working with a hospital or unit-based practice committee to create a facility-specific guideline or resource.Because patients requiring this therapy may be infrequent, facilities would benefit from creating relevant resources that nurses can reference quickly at the point of care.9 When specific evidence-based guidelines are not available, nurses can use their existing, related knowledge to anticipate complications and provide safe care.

Acoustic emissions from echocontrast agents infused through an EkoSonic endovascular system in vitro

The objective of this study was to explore the location and amount of cavitation nucleation from Definity® or drug-loaded echogenic liposomes infused through the EkoSonic endovascular system (Boston Scientific, Arden Hills, MN) in an in vitro model mimicking porcine femoral arterial flow. Passive cavitation images were acquired during echocontrast agent infusion and 2.2 MHz EkoSonic ultrasound exposure over a range of ultrasound drive powers (4 W-47 W), and the ultraharmonic and inharmonic energy patterns were compared.

Image compositing for simultaneous passive imaging of stable and inertial cavitation

For image guidance of ultrasound-mediated drug delivery using Definity® infusions through the Ekosonic Endovascular System (Boston Scientific, Arden Hills, MN), composite cavitation images were formed using ultraharmonic and inharmonic energy values in the green and red channels, respectively, and overlayed on B-mode images. The extension of the traditional 1D color bar to a 2D color map enabled simultaneous display of ultraharmonic and inharmonic energy, coupled with B-mode imaging for spatial localization.

Cavitation Emissions Nucleated by Definity Infused through an EkoSonic Catheter in a Flow Phantom

The EkoSonic endovascular system has been cleared by the U.S. Food and Drug Administration for the controlled and selective infusion of physician specified fluids, including thrombolytics, into the peripheral vasculature and the pulmonary arteries. The objective of this study was to explore whether this catheter technology could sustain cavitation nucleated by infused Definity, to support subsequent studies of ultrasound-mediated drug delivery to diseased arteries. The concentration and attenuation spectroscopy of Definity were assayed before and after infusion at 0.3, 2.0 and 4.0 mL/min through the EkoSonic catheter. PCI was used to map and quantify stable and inertial cavitation as a function of Definity concentration in a flow phantom mimicking the porcine femoral artery. The 2.0 mL/min infusion rate yielded the highest surviving Definity concentration and acoustic attenuation. Cavitation was sustained throughout each 15 ms ultrasound pulse, as well as throughout the 3 min infusion. These results demonstrate a potential pathway to use cavitation nucleation to promote drug delivery with the EkoSonic endovascular system.

Massive pulmonary embolism in patients with extreme bleeding risk: a case series on the successful use of ultrasound-assisted, catheter directed thrombolysis in a district general hospital

Massive pulmonary embolism (PE), characterised by profound arterial hypotension, is a life-threatening emergency with a 90-day mortality of over 50%. Systemic thrombolysis can significantly reduce the risk of death or cardiovascular collapse in these patients, by around 50%, but these benefits are offset by a fivefold increased risk of intracranial haemorrhage and major bleeding, which may limit its use in patients at high risk of catastrophic haemorrhage. We describe a case series of 3 patients presenting with massive PE, each with extreme risk of bleeding and contra-indication to systemic thrombolysis, treated successfully with ultrasound-assisted, catheter directed thrombolysis (U-ACDT). Our experience of this novel technique using the EkoSonic Endovascular System (Ekos, BTG, London, UK) on carefully selected patients has demonstrated the potential to improve clinical status in shocked patients, with minimal bleed risk. There have been several clinical studies evaluating the Ekos system. Both the ULTIMA and SEATTLE II studies have shown significant reductions in RV/LV ratio by CT scanning when compared to standard anticoagulation in patients with intermediate-risk PE, with minimal bleeding complications. However, there is a pressing need for a randomised trial demonstrating improvement in robust clinical outcomes when comparing U-ACDT to simple anticoagulation. We believe that this case series adds new insight and highlights the potential of catheter directed thrombolysis in this high-risk patient cohort and consideration should be made to its use in cases where systemic thrombolysis is felt to be too high risk.

Predictors of Treatment Response Following Ultrasound-Facilitated Catheter-Directed Thrombolysis for Submassive and Massive Pulmonary Embolism: A SEATTLE II Substudy.

Little is known about which factors predict improvement in clinical and imaging parameters among patients undergoing catheter-directed thrombolysis for submassive or massive pulmonary embolism. The identification of such predictors may allow for more appropriate patient selection for ultrasound-facilitated catheter-directed thrombolysis. We conducted a retrospective cohort analysis of patients from the SEATTLE II trial (Prospective, Single-Arm, Multi-Center Trial of EkoSonic Endovascular System and Activase for Treatment of Acute Pulmonary Embolism) to identify clinical characteristics that independently predict pulmonary artery pressures, right ventricular-to-left ventricular (RV/LV) diameter ratio, and modified Miller angiographic index following ultrasound-assisted catheter-directed thrombolysis. Eligible patients had submassive or massive pulmonary embolism and an RV/LV diameter ratio ≥0.9 on chest computed tomography. Multivariable linear regression was used to identify independent clinical predictors of each outcome. One hundred fifty patients with massive (n=31) or submassive (n=119) pulmonary embolism were enrolled. Mean (±SD) baseline and postprocedure RV/LV diameter ratio, pulmonary artery systolic pressure, and modified Miller Score were 1.59 (±0.39) and 1.14 (±0.2), 51.45 (±16.0), and 37.47 (±11.9), and 23.0 (±5.7) and 15.7 (±5.9), respectively. The multivariable model adjusted R2 for absolute change in RV/LV ratio, pulmonary artery systolic pressure, modified Miller Score was 0.71, 0.57, and 0.43, respectively. After adjusting for age, gender, and baseline RV/LV ratio, pulmonary artery systolic pressure, and modified Miller Score, patients with higher body mass index, renal or hepatic dysfunction, active smoking, or a higher baseline heart rate showed less improvement. Patients with more life-threatening pulmonary embolism may derive the greatest benefit from ultrasound-assisted, catheter-directed thrombolysis.

The Role of EkoSonic Endovascular System or EKOS® in Pulmonary Embolism.

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.

EkoSonic Endovascular System for patients with acute pulmonary embolism and contraindication to systemic fibrinolysis.

The aim of this study was to evaluate the safety and efficacy of the EkoSonic Endovascular System (EKOS) in patients with acute pulmonary embolism (APE) at high or intermediate-high risk and contraindication to systemic fibrinolysis. This is a retrospective study including consecutive patients admitted due to high-risk or intermediate-high-risk APE and treated by EKOS because of an absolute or relative contraindication to systemic fibrinolysis. The primary efficacy end-point was the change from baseline to 72 h in right to left ventricular dimension ratio [right ventricular/left ventricular (RV/LV) ratio]; pulmonary embolic burden using the Qanadli Index; and systolic pulmonary arterial pressure (SPAP). The primary safety end-point was the occurrence of bleeding (GUSTO classification) within 72 h. Eighteen patients (5 men, 13 women; mean age 74 ± 12.7 years) affected by high-risk APE (n = 5; 27.8%) or intermediate-high-risk APE (n = 13; 72.2%) were included. A significant reduction of mean RV/LV ratio (1.38 ± 0.3 vs. 0.97 ± 0.16; P < 0.0005); Qanadli Index [27.06 ± 2.6 vs. 18.8 ± 7.8 (P < 0.001) and SPAP (71.1 ± 12 vs. 45.2 ± 16 mmHg; P < 0.001)] was observed within 72 h after EKOS. Five bleeding events occurred: one fatal and four moderates; three out of them led to the access site hematoma, two due to pre-existing active bleeding. EKOS is an effective tool to treat patients with APE at high or intermediate-high risk and contraindication to fibrinolysis. It is a relatively safe therapy considering the critical conditions and high bleeding risk of the receiving population.

Ultrasound-Accelerated Thrombolysis has Higher Success and Limb Salvage Rates and Similar Costs Compared to Catheter-Directed Thrombolysis for Acute Limb Ischemia

gdfh: Ultrasound-accelerated thrombolysis (UAT) has become an alternative to catheter-directed thrombolysis (CDT) for the treatment of acute limb ischemia. The purpose of this study was to compare outcomes and hospital costs for these two treatments. Methods: The records of all patients treated with UAT (using the EkoSonic Endovascular System, EKOS Corp, Bothell, Washington) and CDT (standard side-hole catheter) at a single institution from January 2007 through December 2010 were reviewed. Patient demographics, treatment times, procedural outcomes, complications, lengths of stay, and hospital economic data were analyzed. Results: A total of 85 patients were treated; 43 underwent UAT and 42 had CDT. Both treatment groups had similar comorbidities and prior vascular procedures. Overall, 85.9% had a previous vascular procedure with 52 prosthetic bypass grafts. UAT was successful in 41/43 patients (95.3%), whereas CDT was successful in 28/42 (66.7%, P=.0019). Median total treatment time for the UAT group was 21.29 hours versus 56.53 hours for the CDT group (P=.000). Length of stay was also less for the UAT group (5.65 vs 8.26 days, P=.027). 30-d amputation rate was significantly higher in the CDT group (42.9% vs 18.6%, P<.01). There was a significantly higher bleeding rate in the CDT (23.8% vs 4.7%, P<.01). Total procedural costs were similar for both groups ($18,270 for UAT vs $16,650 for CDT, P=.366), as were total admission direct costs ($19,556 for UAT vs $18,520 for CDT, P=.685). Conclusion: UAT has higher success rates, shorter treatment times, higher limb salvage, less bleeding complications, and shorter lengths of stay than patients undergoing CDT. Despite the favorable clinical outcome for UAT, total procedural costs and total admission direct costs remain similar. Our institution has chosen to employ standardized techniques using UAT in order to improve outcomes and decrease complications in the future.Objectives: Ultrasound-accelerated thrombolysis (UAT) has become an alternative to catheter-directed thrombolysis (CDT) for the treatment of acute limb ischemia. The purpose of this study was to compare outcomes and hospital costs for these two treatments. Methods: The records of all patients treated with UAT (using the EkoSonic Endovascular System, EKOS Corp, Bothell, Washington) and CDT (standard side-hole catheter) at a single institution from January 2007 through December 2010 were reviewed. Patient demographics, treatment times, procedural outcomes, complications, lengths of stay, and hospital economic data were analyzed. Results: A total of 85 patients were treated; 43 underwent UAT and 42 had CDT. Both treatment groups had similar comorbidities and prior vascular procedures. Overall, 85.9% had a previous vascular procedure with 52 prosthetic bypass grafts. UAT was successful in 41/43 patients (95.3%), whereas CDT was successful in 28/42 (66.7%, P=.0019). Median total treatment time for the UAT group was 21.29 hours versus 56.53 hours for the CDT group (P=.000). Length of stay was also less for the UAT group (5.65 vs 8.26 days, P=.027). 30-d amputation rate was significantly higher in the CDT group (42.9% vs 18.6%, P<.01). There was a significantly higher bleeding rate in the CDT (23.8% vs 4.7%, P<.01). Total procedural costs were similar for both groups ($18,270 for UAT vs $16,650 for CDT, P=.366), as were total admission direct costs ($19,556 for UAT vs $18,520 for CDT, P=.685). Conclusion: UAT has higher success rates, shorter treatment times, higher limb salvage, less bleeding complications, and shorter lengths of stay than patients undergoing CDT. Despite the favorable clinical outcome for UAT, total procedural costs and total admission direct costs remain similar. Our institution has chosen to employ standardized techniques using UAT in order to improve outcomes and decrease complications in the future.

EkoSonic Thrombolysis as a Therapeutic Adjunct in Venous Occlusive Disease.

The use of ultrasound waves in conjunction with local thrombolysis may accelerate clot resolution and serve as an important therapeutic adjunct in the treatment of venous occlusive disease. Our goal was to provide a larger sample population over a 5-year period to evaluate our experience with the EkoSonic endovascular system (EKOS, EKOS Corporation, Bothell, WA). We suspected that ultrasound-accelerated thrombolysis (UAT) using EKOS would provide excellent thrombolysis and midterm patency rates with minimal thrombolytic complications. A retrospective study was conducted to provide a case series with UAT using EKOS. Data were collected over a 5-year period. Primary end points included degree of thrombolysis. Secondarily, we analyzed thrombolytic usage, complication rates, and midterm patency, over a 1-year period. A total of 48 limbs were treated with UAT. Forty cases were diagnosed as acute, whereas the remaining 8 were chronic. Complete thrombolysis was successful in 38/48 (79%) of patients, and partial thrombolysis was accomplished in 10/48 (21%) of patients. Overall mean infusion time was 22.4 hours ±3.6. There were a total of three complications (6%), all of which were minor bleeding. One-year patency was shown to be 87% with no signs of valvular reflux. UAT using EKOS demonstrated effective rates of thrombolysis with very few complications. In addition, our 1-year patency rates were comparable to published data using conventional catheter-directed thrombolysis. UAT provides lytic therapy by utilizing the benefits of ultrasonic waves to help augment the fibrinolytic process. Our institution currently favors the use of EKOS as the treatment of choice in patients that are appropriate thrombolytic candidates.

Percutaneous treatment of pulmonary embolism: diffusion and use of the technique in Italian interventional cardiology centers. Results of the PETER survey

Reperfusion in acute pulmonary embolism (PE) by percutaneous techniques is a valid therapeutic option when there is a formal contraindication to or failure of thrombolysis. In the last years, an increasing number of patients with acute PE have been treated with these techniques. In order to obtain a map of current availability and use of percutaneous techniques in PE, on behalf of the ANMCO Pulmonary Circulation Area, 56 Italian interventional cardiology and radiology departments, equipped with technology for percutaneous embolectomy, were invited to participate in a national survey. Questionnaires were e-mailed to each department from April to May 2015. Thirty-one out of 56 centers (54.8% in the North, 9.7% in the Center and 35.5% in the South of Italy) answered to the questionnaire. Percutaneous techniques were available in 90% of the cardiology departments involved, reporting also a good experience with their use in PE (77.4%). Only two responders were interventional radiology departments. AngioJet(®) and EkoSonic Endovascular System(®) (64.7% and 19.4%, respectively) were the most common devices used. Overall, in 2014, 62 patients were treated with percutaneous techniques, mainly in the North of the country. With regard to local diagnostic and therapeutic protocols, 61.3% of respondents reported owning one. Great interest was provided by participants in adhering to this national multicenter registry. Our results show the interest of Italian cardiology departments about percutaneous techniques as a therapeutic option for acute PE. Percutaneous techniques are largely available but still underused in routine clinical practice.

Endovascular Management of Acute Pulmonary Embolism Using the Ultrasound-Enhanced EkoSonic System.

Acute, symptomatic pulmonary embolism (PE) in the massive and submassive categories continues to be a healthcare concern with significant risk for increased morbidity and mortality. Despite increased awareness and venous thromboembolism prophylaxis, endovascular treatment is still an important option for many of these patients. There are a variety of techniques and devices used for treating PE, but none have been evaluated as extensively as the EkoSonic endovascular system that is also currently the only FDA-approved device for the treatment of pulmonary embolism. This article describes the use of the EkoSonic device for this patient population.

THE EKOSONIC® ENDOVASCULAR SYSTEM PROVIDES IMPROVEMENTS IN THROMBOTIC BURDEN, PULMONARY ARTERIAL PRESSURES AND RIGHT ATRIAL AND VENTRICULAR FUNCTIONS IN PATIENTS WITH ACUTE PULMONARY EMBOLISM AT HIGH OR INTERMEDIATE-HIGH RISK: A SINGLE-CENTER EXPERIENCE

In patients with acute pulmonary embolism (APE), a novel catheter-directed treatment technology, EkoSonic® Endovascular System (EKOS) is reported to facilitate the thrombolysis with a reduced bleeding risk. This single-center study based on the retrospective evaluation of the 44 patients with