Treatment Of Pulmonary Embolism Research Articles

Interventional therapy of pulmonary embolism - update

Several catheter-based systems have been developed for interventional recanalization of pulmonary embolism. These include local ultrasound assisted thrombolysis (EKOS), in-toto-thrombectomy via retriever and aspiration system (FlowTriever) and the Indigo mechanical aspiration system. Safety and efficacy in the removal of thrombus have been demonstrated for all systems. Interventional recanalization strategies for high- and intermediate-high risk pulmonary embolism are potentially more effective in the removal of thrombus and restoration of right heart function than systemic thrombolysis with a lower risk of major bleeding complications. Preliminary data from registries and observational studies are very promising whereas the evidence for systemic thrombolysis treatment in high and intermediate-high risk pulmonary embolism is low. Randomized controlled clinical trials are currently performed comparing catheter based interventional therapies to systemic thrombolysis for the treatment of intermediate-high risk pulmonary embolisms. Primary outcome measurements include mortality, hemodynamic collapse, and major bleedings. Results are expected in 2025. The introduction of interventional therapies for pulmonary embolism was accompanied by an increased awareness of the complexity of pulmonary embolism management. The need for specialized interdisciplinary pulmonary embolism response teams (PERT-teams) and a well-structured approach including a PDCA cycle was recognized.

Experience in the use of non-immunogenic recombinant staphylokinase in the treatment of massive pulmonary embolism

Experience in the use of non-immunogenic recombinant staphylokinase in the treatment of massive pulmonary embolism

Is it safe to discontinue anticoagulant after surgical treatment of varicose vein disease, which caused pulmonary embolism?

Superficial vein thrombosis, which is mostly caused by lower extremity varicose vein disease, can be complicated by pulmonary embolism. At the same time, the optimal duration of anticoagulant therapy for pulmonary embolism originated from varicose vein thrombosis is still under debate. On the one hand, the presence of varicose veins is considered a small risk factor for the development of venous thromboembolic events, which persistence determines an increased risk of relapse and requires prolonged anticoagulant therapy. On the other hand, elimination of varicose veins is associated with reduced risk of subsequent venous thromboembolic events. The article describes a clinical case of recurrent pulmonary embolism after surgical treatment of varicose vein disease, which caused primary pulmonary embolism. A 45-year-old patient suffering from left lower extremity varicose vein disease for 5 years was admitted to the intensive care unit with suspected pulmonary embolism. The further examination revealed signs of thrombotic occlusion of the segmental and subsegmental branches of the pulmonary arteries bilaterally and the middle lobe branch of the right pulmonary artery, as well as signs of the right-sided heart overload. In this case, pulmonary embolism was found to originate from thrombosis of the trunk of the great saphenous vein ofthe left lower extremity with a proximal border at the level of the lower leg. No signs of deep vein involvement were detected. The parenteral anticoagulant therapy initiated in the hospital was followed by switching to therapeutic doses of rivaroxaban. The signs of recanalization of involved veins were identified after 6 months of treatment, and it was decided to perform endovenous laser coagulation of the trunk of the great saphenous vein combined with mini-phlebectomy of varicose tributaries on continuous oral anticoagulant therapy. The rivaroxaban therapy was completed a month after intervention. However, 7 days later the patient was diagnosed with repeated symptomatic pulmonary embolism, which originated from thrombosis of the left popliteal vein. It was recommended to resume anticoagulant therapy of indefinite duration. The article discusses the issues of optimal duration of treatment for pulmonary embolism originated from thrombosis of superficial varicose veins, as well as the possible timing of completion of anticoagulant therapy after the intervention.

First-Line Treatment for Massive Pulmonary Embolism: Counterpoint-Tried-and-True Catheter-Directed Thrombolysis Is a More-Established Therapy for Massive Pulmonary Embolism.

First-Line Treatment for Massive Pulmonary Embolism: Counterpoint-Tried-and-True Catheter-Directed Thrombolysis Is a More-Established Therapy for Massive Pulmonary Embolism.

First-Line Treatment for Massive Pulmonary Embolism: Point-Catheter-Directed Mechanical Thrombectomy May Challenge the Treatment Algorithm.

First-Line Treatment for Massive Pulmonary Embolism: Point-Catheter-Directed Mechanical Thrombectomy May Challenge the Treatment Algorithm.

Assessing PERT integration: a European survey on pulmonary embolism response teams

Abstract Funding Acknowledgements None. Background In recent years, the establishment of multidisciplinary pulmonary embolism response teams (PERTs) has become more prevalent in response to the growing challenges in managing acute pulmonary embolism (PE). A survey was conducted to assess the availability and structure of PERTs in selected European PE reference centers. Methods A survey was circulated among leading European PE centers to obtain data on their current PE treatments, the existence and features of PERTs, their activation methods, and their structural organization. Additionally, data regarding PE treatment priority relative to acute coronary syndrome and the availability of outpatient PE follow-up programs was collected. Results Overall, 26 selected reference centers for PE from 13 European countries participated at this survey and in more than four fifth (80.8%) of the centers PERT is already implemented. Although 76.9% of the centers handle over 40 PE cases annually, less than half (42.8%) of their PE cases are discussed in a PERT meeting. Figure 1A illustrates the risk classifications for which PERTs are typically consulted. The most common method of activating PERTs is through phone calls (47.6%), followed by mobile apps (38.1%) and pagers (4.8%). In almost 60% PERT is leading from the Department of Cardiology followed by Pulmonology (18.2%), Critical Care Medicine (9.1%), General Internal Medicine (4.6%), Angiology (4.6%) and Radiology (4.6%) (Figure 1B and 1C). Regarding advanced treatment the majority of European expert centers for PE offers catheter-directed thrombolysis (78.3%) and catheter-based thrombectomy (78.3%) and the opportunity of surgical embolectomy (65.2%). Notably, over 46% of centers prioritize ST-elevation infarction over high-risk PE (Figure 1D). The follow-up of patients with PE is organized in 34.6% in a dedicated PE clinic, in 23.1%in the clinic of the physician leading PERT and in 7.7% no PE follow-up is available. Conclusion The findings confirm the widespread adoption of PERTs in European PE reference centers. However, there is a discernible trend of prioritizing myocardial infarction over PE with hemodynamic instability, even when mortality rates are comparable for high-risk PE cases. This emphasizes the pressing need for awareness campaigns to enlighten physicians about the significant mortality rates linked with unstable PE, aiming for enhanced management and intervention for this thrombotic disease.

Pharmacological and Nonpharmacological Interventions for Prevention and Management of Pulmonary Embolism in Patients with Cardiac Comorbidities: A Literature Review

Pulmonary embolism (PE) presents significant healthcare challenges and potentially life-threatening consequences, demanding a nuanced approach to management. This systematic review aimed to critically evaluate available pharmacological and nonpharmacological interventions for PE, analyzing their efficacy and safety in patients with cardiac comorbiditie, ranging from traditional anticoagulants like warfarin to novel direct oral anticoagulants (DOACs) or thrombolytic therapies is commercially available options with varying benefits and limitations. Nonpharmacological interventions, including catheter-directed therapies and embolectomy, provide alternative avenues, especially when thrombolysis is contraindicated despite advancements, and gaps persist, particularly in reconciling efficacy with safety profiles and optimizing resource allocation. Addressing these challenges necessitates a multidisciplinary approach, integrating clinical expertise with evidence-based practices. By exploring these interventions' intricacies and implications, this review aims to inform clinicians, researchers, and policymakers, fostering improved care pathways and better outcomes for patients facing the complex landscape of PE management.

Treatment of Pulmonary Embolism beyond Anticoagulation.

Treatment of Pulmonary Embolism beyond Anticoagulation.

Clinical, Functional, and Quality-of-Life Outcomes after Computer-Assisted Vacuum Thrombectomy for Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study

PurposeTo report the first interim analysis of the STRIKE-PE study, evaluating the safety and effectiveness of computer-regulated aspiration thrombectomy for the treatment of acute pulmonary embolism (PE). Materials and MethodsThis prospective, international, multicenter study will enroll 600 adult patients with acute PE of ≤14 days and a right ventricle (RV)–to–left ventricle (LV) ratio of ≥0.9 who receive first-line endovascular treatment with computer-assisted vacuum thrombectomy (CAVT) using the Indigo Lightning system (Penumbra, Alameda, California). Primary endpoints are change in RV/LV ratio and incidence of composite major adverse events (MAEs) within 48 hours. Secondary endpoints include functional and quality-of-life (QoL) assessments. ResultsThe first 150 consecutive patients were treated with 12-F catheter CAVT. Mean age was 61.3 years, 54.7% were men, 94.7% presented with intermediate-risk PE, and 5.3% presented with high-risk PE. Median thrombectomy and procedure times were 33.5 minutes and 70.0 minutes, respectively, resulting in a mean reduction in systolic pulmonary artery pressure of 16.3% (P < .001). Mean RV/LV ratio decreased from 1.39 to 1.01 at 48 hours, a 25.7% reduction (P < .001). Four (2.7%) patients experienced a composite MAE within 48 hours. At 90-day follow-up, patients exhibited statistically significant improvements in the Borg dyspnea scale scores and QoL measures, and the New York Heart Association class distribution returned to that reported before the index PE. ConclusionsInterim results from the STRIKE-PE study demonstrate a significant reduction in pulmonary artery pressure and RV/LV ratio, procedure times of <2 hours, composite MAE rate of 2.7%, and significant improvements in 90-day functional and QoL outcomes.

A Safety and Feasibility Single-Arm Study of a Novel Catheter Thrombectomy Device for the Treatment of Pulmonary Embolism (ENGULF)

A Safety and Feasibility Single-Arm Study of a Novel Catheter Thrombectomy Device for the Treatment of Pulmonary Embolism (ENGULF)

LB-8 | First in Human Safety and Feasibility of a Novel Catheter Thrombectomy Device for the Treatment of Pulmonary Embolism (The ENGULF Trial)

LB-8 | First in Human Safety and Feasibility of a Novel Catheter Thrombectomy Device for the Treatment of Pulmonary Embolism (The ENGULF Trial)

Structured benefit-risk assessment for enoxaparin, in the context of its label extension, for the extended treatment of deep vein thrombosis and pulmonary embolism, and prevention of its recurrence in patients with active cancer.

Guidelines recommend low-molecular-weight heparins (LMWHs) for patients with cancer-associated thrombosis. However, until recently, only dalteparin and tinzaparin were approved in the European Economic Area (EEA) for these patients. This study compares the benefit-risk profile of enoxaparin with dalteparin and tinzaparin for the extended treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrence in adult patients with active cancer. A semi-quantitative structured benefit-risk assessment was conducted for the label-extension application of enoxaparin based on the benefit-risk action team descriptive framework: define decision context; determine key benefit and risk outcomes; identify data sources; extract data; interpret results. The key benefits were defined as reduced all-cause mortality and venous thromboembolism (VTE) recurrence (including symptomatic DVT, fatal PE or non-fatal PE); the key risks were major and non-major bleeding of clinical significance, and heparin-induced thrombocytopenia (HIT). Enoxaparin demonstrated comparable effects for the reduction of VTE recurrence and all-cause mortality versus other EEA-approved LMWHs (dalteparin, tinzaparin). There was no evidence of a significant difference between enoxaparin and the comparator groups with regard to incidence of major and non-major bleeding. The data on HIT were too limited to assess the difference between the two groups. The assessment demonstrated a favourable benefit-risk profile for enoxaparin similar to that of other EEA-approved LMWHs for the treatment of DVT and PE and the prevention of recurrence in patients with active cancer and thus supported the label-extension approval.

Electrocardiographic Changes after Endovascular Mechanical Thrombectomy in a Patient with Pulmonary Embolism-A Case Report and Literature Review.

Background: Pulmonary embolism (PE) is a common disease with an annual incidence of about 1/1000 persons. About every sixth patient dies within the first 30 days after diagnosis. The electrocardiogram (ECG) is one of the first diagnostic tests performed, and is able to confirm the suspicion of PE with typical electrocardiographic signs. Some ECG signs and their regression are also prognostically relevant. Endovascular mechanical thrombectomy is one option for PE treatment, and aims to relieve right heart strain immediately. The first studies on endovascular mechanical thrombectomy using a dedicated device (FlowTriever System, Inari Medical, Irvine, CA, USA) yielded promising results. Methods: In the following, we report the case of a 66-year-old male patient who presented with New York Heart Association III dyspnea in our emergency department. Among typical clinical and laboratory results, he displayed very impressive electrocardiographic and radiological findings at the time of PE diagnosis. Results: After endovascular mechanical thrombectomy, the patient's complaints and pulmonary hemodynamics improved remarkably. In contrast, the ECG worsened paradoxically 18 h after intervention. Nevertheless, control echocardiography 4 days after the intervention no longer showed any signs of right heart strain, and dyspnea had disappeared completely. At a 4-month follow-up visit, the patient presented as completely symptom-free with a high quality of life. His ECG and echocardiography were normal and excluded recurrent right heart strain. Conclusions: Overall, the patient benefitted remarkably from endovascular mechanical thrombectomy, resulting in an almost complete resolution of electrocardiographic PE signs at the 4-month follow-up after exhibiting multiple typical electrocardiographic PE signs at time of diagnosis and initial electrocardiographic worsening 18 h post successful intervention.

Role of Extracorporeal Membrane Oxygenation in the Treatment of Massive Pulmonary Embolism

Role of Extracorporeal Membrane Oxygenation in the Treatment of Massive Pulmonary Embolism

Lightning 12 - an intelligent computer-assisted vacuum aspiration thrombectomy system in the treatment of pulmonary embolism: An initial experience.

Lightning 12 - an intelligent computer-assisted vacuum aspiration thrombectomy system in the treatment of pulmonary embolism: An initial experience.

PULMONARY EMBOLISM MANAGEMENT CHALLENGES IN DIAGNOSTIC AND TREATMENT OF 81 YEAR OLD MAN IN THE SETTING OF RURAL AREA WITH LIMITED RESOURCES : A CASE REPORT

Background: Pulmonary embolism is a cardiology emergency with a high mortality rate that is hard to diagnose for its symptoms. The adequate diagnosis of pulmonary embolism requires advanced laboratory and imaging facilities which are not widely available in Indonesia. The lack of facilities and pharmacological availability is an important problem for the delay of treatment and diagnosis of pulmonary embolism will increase the mortality number. This case reports on a patient with pulmonary embolism, managed in a limited healthcare facility. Case Illustration: A-81-year-old Man came with sudden dyspnea and hemoptoe. Physical examination showed mild tachycardia, a drop of blood saturation, and signs of right heart failure. His ECG showed deep S wave in lead I, Q wave in lead III (McGinn-white sign), P pulmonary in lead II, III, aVF, inverted T in inferior and anterior lead. Diagnosis were determined by the clinical score and the ECG pattern. The patient showed hemodynamic instability and was included as a high-risk pulmonary embolism, therefore systemic thrombolysis should be the goal therapy for this patient. Due to the unavailability of systemic thrombolysis, systemic anticoagulant therapy using fondaparinux sodium was initiated and hemodynamic support was given. The patient developed refractory shock despite the usage of the hemodynamic support and died after 5 days of hospitalization. Conclusion: The limitation of diagnostic tools and therapy is one of the biggest challenges in rural hospitals for it can increase the mortality rate of PE Patients. The procurement of diagnostic modalities and pharmacology therapies should be carried out in all hospitals in Indonesia to provide the best management for the patient.

A cross-sectional study of outcomes for patients undergoing mechanical thrombectomy for pulmonary embolism during 2018-2022: Insights from the PINC AI Healthcare Database.

Mechanical thrombectomy (MT) treatments for pulmonary embolism (PE) have yet to be compared directly. We aimed to determine if patient outcomes varied following treatment of PE with different MT devices. All PE encounters with an index treatment of MT between January 2018 and March 2022 were analyzed for in-hospital mortality, discharge to home, and 30-day readmission outcomes in the PINC AI™ Healthcare Database. MT devices used in each encounter were extracted from hospital charge description free-text fields using keyword text and fuzzy matching. Unadjusted and adjusted logistic regression was used to model outcomes by device. A total of 5893 encounters were identified using MT as the sole index PE treatment and 1812 using MT with another treatment. Of these, 41% had insufficient information to identify the devices used (unspecified MT), 33% used the FlowTriever System (large-bore volume-controlled aspiration MT), 23% the Indigo System (continuous aspiration MT), and 3% some other MT. Large-bore volume-controlled aspiration MT was used with other treatments 13% of the time compared with 23% and 39% for unspecified MT and continuous aspiration MT, respectively. Adjusted logistic regression modeling revealed the odds of in-hospital mortality were significantly higher for patients treated with unspecified MT ([OR] = 1.42, 95% confidence interval [CI]: [1.10-1.83], p = 0.008) or continuous aspiration MT (OR = 1.63, 95% CI: [1.21-2.19], p = 0.001) compared with large-bore volume-controlled aspiration MT. Discharge to home was significantly lower in these same groups (OR = 0.84, 95% CI: [0.73-0.96], p = 0.01, and OR = 0.63, 95% CI: [0.53-0.74], p < 0.001, respectively), but readmission risks at 30 days were comparable (OR = 1.08, 95% CI: [0.84-1.38], p = 0.56, and OR = 1.20, 95% CI: [0.89-1.62], p = 0.24, respectively). PE outcomes and treatment patterns differ significantly based on the type of MT utilized. Clinical studies directly comparing MT treatments are needed to further understand optimal treatment of PE.

Pulmonary Embolism Treatment: Current Developments and Approaches

Pulmonary Embolism Treatment: Current Developments and Approaches

Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives.

Pulmonary embolism (PE) is a potentially life-threatening condition requiring prompt diagnosis and treatment. Recent advances have led to the development of newer techniques and drugs aimed at improving PE management, reducing its associated morbidity and mortality and the complications related to anticoagulation. This review provides an overview of the current knowledge and future perspectives on PE treatment. Anticoagulation represents the first-line treatment of hemodynamically stable PE, direct oral anticoagulants being a safe and effective alternative to traditional anticoagulation: these drugs have a rapid onset of action, predictable pharmacokinetics, and low bleeding risk. Systemic fibrinolysis is suggested in patients with cardiac arrest, refractory hypotension, or shock due to PE. With this narrative review, we aim to assess the state of the art of newer techniques and drugs that could radically improve PE management in the near future: (i) mechanical thrombectomy and pulmonary embolectomy are promising techniques reserved to patients with massive PE and contraindications or failure to systemic thrombolysis; (ii) catheter-directed thrombolysis is a minimally invasive approach that can be suggested for the treatment of massive or submassive PE, but the lack of large, randomized controlled trials represents a limitation to widespread use; (iii) novel pharmacological approaches, by agents inhibiting thrombin-activatable fibrinolysis inhibitor, factor Xia, and the complement cascade, are currently under investigation to improve PE-related outcomes in specific settings.

PE-Ynet: a novel attention-based multi-task model for pulmonary embolism detection using CT pulmonary angiography (CTPA) scan images.

Pulmonary Embolism (PE) has diverse manifestations with different etiologies such as venous thromboembolism, septic embolism, and paradoxical embolism. In this study, a novel attention-based multi-task model is proposed for PE segmentation and detection from Computed Tomography Pulmonary Angiography (CTPA) images. A Y-Net architecture is used to implement this model, which facilitates segmentation and classification jointly, improving performance and efficiency. It is leveraged with Multi Head Attention (MHA), which allows the model to focus on important regions of the image while suppressing irrelevant information, improving the accuracy of the segmentation and detection tasks. The proposed PE-YNet model is tested with two public datasets, achieving a maximum mean detection and segmentation accuracy of 99.89% and 99.83%, respectively, on the CAD-PE challenge dataset. Similarly, it also achieves a detection accuracy of 99.75% and a segmentation accuracy of 99.81% on the FUMPE dataset. Additionally, sensitivity analysis also shows a high sensitivity of 0.9885 for the localization error ɛ = 0 for the CAD-PE dataset, demonstrating the model's robustness against false predictions compared to state-of-the-art models. Further, this model also exhibits lower inference time, size, and memory usage compared to representative models. An automated PE-YNet tool can assist physicians with PE diagnosis, treatment, and prognosis monitoring in the clinical management of CoVID-19.