Sandeep Bagla1, John B Smirniotopoulos2, Arletta van Breda2, Michael J Sheridan2, Keith M Sterling3. 1. Association of Alexandria Radiologists, PC, Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304. Electronic address: sbagla@alexandriaradiology.com. 2. Inova Health System, Falls Church, Virginia. 3. Association of Alexandria Radiologists, PC, Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304.
Abstract
PURPOSE: To evaluate the safety and efficacy of ultrasound-accelerated catheter-directed thrombolysis (USAT) in patients with submassive pulmonary embolism (PE). MATERIALS AND METHODS: This retrospective study comprised 45 consecutive patients (15 prospective, 30 retrospective) who underwent USAT for submassive PE from June 2012-May 2014. Inclusion criteria were right ventricular dysfunction (RVD) as indicated by right ventricle-to-left ventricle (RV:LV) ratio > 0.9, symptoms of < 2 weeks' duration, and absence of absolute contraindication to thrombolysis. All patients underwent pulmonary artery catheterization with a standardized protocol (24 mg recombinant tissue plasminogen activator). Hemodynamic evaluation immediately after USAT, RV:LV ratio evaluation at 48-72 hours after USAT by computed tomography angiography and echocardiography, and adverse event reporting for a minimum of 30 days were performed. Outcomes and complications are reported as per the Society of Interventional Radiology Reporting Standards for Endovascular Treatment of Pulmonary Embolism. RESULTS: USAT was technically successful in 100% (n = 45) of patients. Main pulmonary artery pressure significantly decreased from 49.8 mm Hg to 31.1 mm Hg (P < .0001). RVD significantly improved with mean RV:LV ratios decreasing from 1.59 to 0.93 (P < .0001). There were 6 complications: 4 minor bleeding episodes at access sites and 2 major bleeding complications (flank and arm hematoma). All-cause mortality at 30 days was 0%. There were no readmissions for PE at 30 days after discharge. CONCLUSIONS: Ultrasound-accelerated catheter-directed thrombolysis using a standardized low-dose protocol is a safe and efficacious method of treatment of submassive PE to reduce acute pulmonary hypertension and RVD.
PURPOSE: To evaluate the safety and efficacy of ultrasound-accelerated catheter-directed thrombolysis (USAT) in patients with submassive pulmonary embolism (PE). MATERIALS AND METHODS: This retrospective study comprised 45 consecutive patients (15 prospective, 30 retrospective) who underwent USAT for submassive PE from June 2012-May 2014. Inclusion criteria were right ventricular dysfunction (RVD) as indicated by right ventricle-to-left ventricle (RV:LV) ratio > 0.9, symptoms of < 2 weeks' duration, and absence of absolute contraindication to thrombolysis. All patients underwent pulmonary artery catheterization with a standardized protocol (24 mg recombinant tissue plasminogen activator). Hemodynamic evaluation immediately after USAT, RV:LV ratio evaluation at 48-72 hours after USAT by computed tomography angiography and echocardiography, and adverse event reporting for a minimum of 30 days were performed. Outcomes and complications are reported as per the Society of Interventional Radiology Reporting Standards for Endovascular Treatment of Pulmonary Embolism. RESULTS:USAT was technically successful in 100% (n = 45) of patients. Main pulmonary artery pressure significantly decreased from 49.8 mm Hg to 31.1 mm Hg (P < .0001). RVD significantly improved with mean RV:LV ratios decreasing from 1.59 to 0.93 (P < .0001). There were 6 complications: 4 minor bleeding episodes at access sites and 2 major bleeding complications (flank and arm hematoma). All-cause mortality at 30 days was 0%. There were no readmissions for PE at 30 days after discharge. CONCLUSIONS: Ultrasound-accelerated catheter-directed thrombolysis using a standardized low-dose protocol is a safe and efficacious method of treatment of submassive PE to reduce acute pulmonary hypertension and RVD.
Authors: Alexandru Marginean; Andrew Putnam; Taishi Hirai; Anthony Serritella; Stephanie A Besser; Margaret Lee; Janet Friant; John Blair; Atman Shah; Sandeep Nathan; Jonathan Chung; Jonathan Paul Journal: J Thromb Thrombolysis Date: 2020-07 Impact factor: 2.300
Authors: Efthymios D Avgerinos; Nathan L Liang; Omar M El-Shazly; Catalyn Toma; Michael J Singh; Michel S Makaroun; Rabih A Chaer Journal: J Vasc Surg Venous Lymphat Disord Date: 2016-01-07
Authors: Maria A de Winter; Einar A Hart; Daniel A F van den Heuvel; Adriaan Moelker; Rutger J Lely; Karin A H Kaasjager; Pieter R Stella; Steven A J Chamuleau; Adriaan O Kraaijeveld; Mathilde Nijkeuter Journal: Cardiovasc Intervent Radiol Date: 2019-03-12 Impact factor: 2.740