BACKGROUND: Catheter-directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. METHODS: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over 2 years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8), or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone. Primary outcome was improvement of RV/LV ratio 24-48 hours after treatment. Safety outcomes included 90-day mortality, bleeding complications, and hospital readmissions. Subgroup analysis based on severity of RV dilation was performed. RESULTS: Mean RV/LV ratio decreased from 1.91±0.61 to 1.28±0.45 (P < .001) in the CDT group and from 1.40 ± 0.37 to 1.25 ± 0.32 (P = .01) in the anticoagulation group. In submassive pulmonary embolisms with mild and moderate RV dilation (RV/LV ratio 0.9-1.9), RV/LV ratio was significantly lower in the CDT group at 24-48 hours (1.05 ± 0.38 vs 1.20 ± 0.31, P < .001). In submassive pulmonary embolisms with severe RV dilation (RV/LV ratio >1.9), no difference was noted between the 2 treatment groups. Ninety-day mortality (11% and 14%, p = 0.7) and incidence of major bleeding complications did not significantly differ between the 2 groups. Thirty-day readmission rates were 8% in the CDT group and 26% in the anticoagulation group (P = .04). CONCLUSION: CDT for acute massive and submassive pulmonary embolism significantly improves RV/LV ratio at 24-48 hours compared with anticoagulation alone and may lower hospital readmission rates. CDT may be more advantageous in patients with mild to moderate RV dilation.
BACKGROUND: Catheter-directed therapy (CDT) offers an alternative treatment to systemic thrombolysis for patients with massive and submassive pulmonary embolism. METHODS: A retrospective review of 105 consecutive massive and submassive pulmonary embolisms over 2 years was performed. Thirty-six patients (9 massive, 27 submassive) were treated with CDT, consisting of aspiration thrombectomy (18), ultrasound-assisted thrombolysis (8), or both (10). Forty-three patients (8 massive, 35 submassive) were treated with heparin anticoagulation alone. Primary outcome was improvement of RV/LV ratio 24-48 hours after treatment. Safety outcomes included 90-day mortality, bleeding complications, and hospital readmissions. Subgroup analysis based on severity of RV dilation was performed. RESULTS: Mean RV/LV ratio decreased from 1.91±0.61 to 1.28±0.45 (P < .001) in the CDT group and from 1.40 ± 0.37 to 1.25 ± 0.32 (P = .01) in the anticoagulation group. In submassive pulmonary embolisms with mild and moderate RV dilation (RV/LV ratio 0.9-1.9), RV/LV ratio was significantly lower in the CDT group at 24-48 hours (1.05 ± 0.38 vs 1.20 ± 0.31, P < .001). In submassive pulmonary embolisms with severe RV dilation (RV/LV ratio >1.9), no difference was noted between the 2 treatment groups. Ninety-day mortality (11% and 14%, p = 0.7) and incidence of major bleeding complications did not significantly differ between the 2 groups. Thirty-day readmission rates were 8% in the CDT group and 26% in the anticoagulation group (P = .04). CONCLUSION:CDT for acute massive and submassive pulmonary embolism significantly improves RV/LV ratio at 24-48 hours compared with anticoagulation alone and may lower hospital readmission rates. CDT may be more advantageous in patients with mild to moderate RV dilation.
Authors: Arkadiusz Pietrasik; Aleksandra Gąsecka; Łukasz Szarpak; Michał Pruc; Tomasz Kopiec; Szymon Darocha; Marta Banaszkiewicz; Maciej Niewada; Marcin Grabowski; Marcin Kurzyna Journal: Front Cardiovasc Med Date: 2022-06-16
Authors: Bedros Taslakian; Clayton Li; Samuel Z Goldhaber; Kathryn Z Mikkelsen; James M Horowitz; Christopher Kabrhel; Geoffrey D Barnes; Akhilesh K Sista Journal: J Clin Med Date: 2019-02-07 Impact factor: 4.241