1
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Bitar R, Bozal SB, Sisti A, Mojibian H, Marino AG, Cornman-Homonoff J. Effect of Filtered Blood Return on Outcomes of Pulmonary Aspiration Thrombectomy. J Vasc Interv Radiol 2024; 35:1447-1456. [PMID: 38950819 DOI: 10.1016/j.jvir.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/30/2024] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
OBJECTIVES To assess the effects of filtered blood reinfusion (FBR) on procedural outcomes of aspiration thrombectomy for pulmonary embolism (PE). MATERIALS AND METHODS A total of 171 patients who underwent aspiration thrombectomy for intermediate-high-risk or high-risk PE between December 2018 and September 2022 were included, 84 of whom underwent thrombectomy with FBR and 87 without. Demographic data, vital signs, laboratory values, procedural details, pulmonary arterial pressures, transfusion needs, length of hospital stay, and procedure-related adverse events were recorded. RESULTS The groups did not differ at baseline, other than the FBR cohort having a higher percentage of women. There was no significant difference in postprocedural vital signs or pulmonary arterial pressure. Mean fluoroscopy time and volume of contrast medium used were lower in the FBR cohort. The drop in hemoglobin level was lower in the FBR group at both 12 (FBR, -1.065; No FBR, -1.742; P > .001) and 24 hours (FBR, -1.526; No FBR, -2.380; P > .001) after procedure; accordingly, fewer patients required transfusions in the FBR cohort (FBR, 8 (9.5%); No FBR, 20 (23.0%); P = .016). There was no difference in the number or severity of adverse events or duration of intensive care unit or hospital admission. CONCLUSIONS FBR use during aspiration pulmonary thrombectomy reduced blood loss and transfusion requirements but had no significant effect on procedural success or adverse event rates.
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Affiliation(s)
- Ryan Bitar
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Suleyman B Bozal
- Yale School of Medicine, New Haven, Connecticut; Department of Biomedical Engineering, Yale School of Engineering and Applied Science, Yale University, New Haven, Connecticut
| | - Anthony Sisti
- Department of Biostatistics, Brown School of Public Health, Brown University, Providence, Rhode Island
| | - Hamid Mojibian
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Angelo G Marino
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Joshua Cornman-Homonoff
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
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2
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Coelho MC, Teixeira R, Nobre C, Thomas B, Lacerda Teixeira B. Systemic Thrombolysis and Catheter-Based Therapies in Acute Pulmonary Embolism. JACC. ADVANCES 2024; 3:101243. [PMID: 39309665 PMCID: PMC11416478 DOI: 10.1016/j.jacadv.2024.101243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Affiliation(s)
| | | | | | - Boban Thomas
- University Hospital Kerry, Tralee, Republic of Ireland
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3
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Dubois-Silva Á, Bikdeli B. Anticoagulant Therapy in Patients Undergoing Acute Pulmonary Embolism Interventions. Interv Cardiol Clin 2024; 13:561-575. [PMID: 39245555 DOI: 10.1016/j.iccl.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
Catheter-based interventions and surgical embolectomy represent alternatives to systemic fibrinolysis for patients with high-risk pulmonary embolism (PE) or those with intermediate-high-risk PE who deteriorate hemodynamically. They are indicated when systemic fibrinolysis is contraindicated or ineffective, or if obstructive shock is imminent. Extracorporeal membrane oxygenation can be added to reperfusion therapies or used alone for severe right ventricular dysfunction and cardiogenic shock. These advanced therapies complement but do not replace anticoagulation, which remains the cornerstone in PE management. This review summarizes the evidence and shares practical recommendations for the use of anticoagulant therapy before, during, and after acute PE interventions.
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Affiliation(s)
- Álvaro Dubois-Silva
- Venous Thromboembolism Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Universidade da Coruña (UDC), A Coruña, Spain; Hospital at Home and Palliative Care Department, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Behnood Bikdeli
- Division of Cardiovascular Medicine and the Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA.
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4
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Tárnoki DL, Karlinger K, Ridge CA, Kiss FJ, Györke T, Grabczak EM, Tárnoki ÁD. Lung imaging methods: indications, strengths and limitations. Breathe (Sheff) 2024; 20:230127. [PMID: 39360028 PMCID: PMC11444493 DOI: 10.1183/20734735.0127-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/24/2024] [Indexed: 10/04/2024] Open
Abstract
Imaging methods are fundamental tools to detect and diagnose lung diseases, monitor their treatment and detect possible complications. Each modality, starting from classical chest radiographs and computed tomography, as well as the ever more popular and easily available thoracic ultrasound, magnetic resonance imaging and nuclear medicine methods, and new techniques such as photon counting computed tomography, radiomics and application of artificial intelligence, has its strong and weak points, which we should be familiar with to properly choose between the methods and interpret their results. In this review, we present the indications, strengths and main limitations of methods for chest imaging.
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Affiliation(s)
- Dávid László Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Oncologic Imaging and Invasive Diagnostic Centre and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Kinga Karlinger
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Carole A Ridge
- Department of Radiology, Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Fanni Júlia Kiss
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Györke
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Elzbieta Magdalena Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Ádám Domonkos Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Oncologic Imaging and Invasive Diagnostic Centre and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
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5
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Rozenbaum Z. Reply: Systemic Thrombolysis and Catheter-Based Therapies in Acute Pulmonary Embolism. JACC. ADVANCES 2024; 3:101246. [PMID: 39309660 PMCID: PMC11416504 DOI: 10.1016/j.jacadv.2024.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Affiliation(s)
- Zach Rozenbaum
- Department of Cardiology, Tulane University, 131 S. Robertson Street, New Orleans, Louisiana 70112, USA. @Rozenbaum_z
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6
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Böhner A, Faron A, Kütting D. [Diagnostics and treatment of pulmonary artery embolisms]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:801-810. [PMID: 39225761 DOI: 10.1007/s00117-024-01364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
In recent years the diagnostics of pulmonary artery embolisms (PE) has gained significance, with confirmation occurring in only about 15-25 % of suspected cases. Despite technological advances, radiological methods remain problematic due to radiation and contrast medium exposure. Clinical scores play a crucial role in the risk assessment of PE. High-risk situations call for specific measures, while negative D‑dimers can help avoid overdiagnosis. Computed tomographic pulmonary angiography (CTPA) remains the gold standard with high sensitivity and specificity. Treatment requires an interdisciplinary team (pulmonary embolism response team, PERT). Anticoagulation is an option for stable patients, while in unstable or unsuccessful courses, thrombolysis or interventional procedures can be considered. Side effects, especially the risk of bleeding, need to be considered for both forms of treatment.
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Affiliation(s)
- Alexander Böhner
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Anton Faron
- Radiologische Allianz Hamburg, Hamburg, Deutschland
| | - Daniel Kütting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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7
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Pebror T, Schmitz AW, Gauger A, Masterson R, Butty SD. Large-bore Aspiration Thrombectomy with the FlowTriever System for the Treatment of Pulmonary Embolism: A Large Single-Center Retrospective Analysis. Cardiovasc Intervent Radiol 2024; 47:1181-1189. [PMID: 39110205 PMCID: PMC11379772 DOI: 10.1007/s00270-024-03819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/19/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE Evaluate the outcomes of patients undergoing large-bore aspiration thrombectomy for the treatment of pulmonary embolism at a large university medical center. MATERIALS AND METHODS All patients treated for pulmonary embolism with the FlowTriever System (Inari Medical, Irvine, CA) between September 2019 and January 2023 were retrospectively analyzed. The primary safety and effectiveness outcomes included 7- and 30-day all-cause mortality, major bleeding, procedure-associated clinical decompensation, pulmonary vascular or cardiac injury, and pulmonary artery pressure reduction. Additional outcomes included technical success (completing thrombectomy with the device as intended), changes in hemodynamics and supplemental oxygen requirements, and postprocedural intensive care unit stay. RESULTS A total of 286 patients were identified. The mean age was 60.5 years, and 90.9% of patients presented with intermediate-risk pulmonary embolism. Technical success was achieved in 96.9% (n = 277) of cases. The average reduction in mean pulmonary arterial pressure was 6.8 mmHg, from 28.7 ± 9.0 to 21.9 ± 8.0 mmHg (p < 0.0001). Two major bleeds (0.7%), 2 pulmonary vascular injuries (0.7%), and 4 (1.4%) procedure-associated decompensations were reported, but no device-related deaths occurred. The mean post-procedure intensive care unit stay was 2.0 ± 4.1 days, and 49.3% of patients had no postprocedural intensive care unit admittance. The overall 7-day and 30-day all-cause mortality rates were 2.4% and 6.7%, respectively, with a 30-day pulmonary embolism-related mortality rate of 3.5%. CONCLUSION This non-industry-sponsored single-center analysis of large-bore aspiration thrombectomy in a large population corroborates the findings of other studies and confirms that this approach is safe and effective for the treatment high- and intermediate-risk pulmonary embolism. LEVEL OF EVIDENCE IV Retrospective observational study.
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Affiliation(s)
- Travis Pebror
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Adam William Schmitz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew Gauger
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Reid Masterson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sabah David Butty
- Indiana University Health Radiology, 714 N Senate Ave, Indianapolis, IN, 46202, USA.
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8
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Kattih Z, Meredith S, Roselli V, Dong V, Varkey A, Saini A, Thampi S, Leung T, Kodra A, Kliger C, Mina B. Mechanical thrombectomy vs catheter directed thrombolysis vs anticoagulation alone: A tertiary center PERT Registry Cohort Analysis. Thromb Res 2024; 241:109114. [PMID: 39126979 DOI: 10.1016/j.thromres.2024.109114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/30/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Zein Kattih
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital/Northwell Health, New York, NY, United States.
| | - Simon Meredith
- Department of Pulmonary and Critical Care Medicine, Lenox Hill Hospital/Northwell Health, New York, NY, United States
| | - Victoria Roselli
- Office of Clinical Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Vincent Dong
- Department of Internal Medicine, Lenox Hill Hospital/Northwell Health, New York, NY, United States
| | - Ashwin Varkey
- Department of Internal Medicine, Lenox Hill Hospital/Northwell Health, New York, NY, United States
| | - Amandeep Saini
- Department of Pulmonary and Critical Care Medicine, NYU Langone - Long Island, Mineola, NY, United States
| | - Shankar Thampi
- Lenox Hill Heart and Lung Cardiology, Lenox Hill Hospital/Northwell Health, New York, NY, United States
| | - Tungming Leung
- Biostatistics Department, Office of Academic Affairs, Northwell Health, Manhasset, NY, United States
| | - Arber Kodra
- Lenox Hill Heart and Lung Cardiology, Lenox Hill Hospital/Northwell Health, New York, NY, United States
| | - Chad Kliger
- Lenox Hill Heart and Lung Cardiology, Lenox Hill Hospital/Northwell Health, New York, NY, United States
| | - Bushra Mina
- Department of Pulmonary and Critical Care Medicine, Northern Westchester, Mt. Kisco, NY, United States
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9
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Henkin S, Ujueta F, Sato A, Piazza G. Acute Pulmonary Embolism: Evidence, Innovation, and Horizons. Curr Cardiol Rep 2024:10.1007/s11886-024-02128-0. [PMID: 39215952 DOI: 10.1007/s11886-024-02128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW Pulmonary embolism (PE) is the third most common cause of cardiovascular morbidity and mortality. The goal of this review is to discuss the most up-to-date literature on epidemiology, diagnosis, risk stratification, and management of acute PE. RECENT FINDINGS Despite an increase in annual incidence rate of PE in the United States and development of multiple advanced therapies for treatment of acute PE, PE-related mortality is not consistently decreasing across populations. Although multiple risk stratification schemes have been developed, it is still unclear which advanced therapy should be used for the individual patient and optimal timing. Fortunately, multiple randomized clinical trials are underway to answer these questions. Nevertheless, up to 50% of patients have persistent reduced quality of life 6 months after acute PE, termed post-PE syndrome. Despite advances in therapeutic options for management of acute PE, many questions remain unanswered, including optimal risk stratification and management of acute PE.
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Affiliation(s)
- Stanislav Henkin
- Gonda Vascular Center, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Francisco Ujueta
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa Sato
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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10
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Cavallino C, Franzino M, Abdirashid M, Maltese L, Bacci E, Rametta F, Ugo F. Novel Challenges and Therapeutic Options for Pulmonary Embolism and Deep Vein Thrombosis. J Pers Med 2024; 14:885. [PMID: 39202076 PMCID: PMC11355608 DOI: 10.3390/jpm14080885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/23/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024] Open
Abstract
Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment options in the management of acute PE and DVT, encompassing both established and emerging technologies, such as catheter-directed thrombolysis, aspiration thrombectomy, and other endovascular techniques. A comprehensive literature review was conducted, assessing clinical studies, trials, and case reports that detail the use of percutaneous interventions for PE and DVT and analyzing the advantages and disadvantages of each percutaneous system. Several percutaneous treatments have shown promising results, especially in cases where rapid thrombus resolution is critical, such as in high- and intermediate-high-risk patients. The incidence of major complications, such as bleeding, remains a consideration, though it is generally manageable with proper patient selection and technique. It is fundamentally important to tailor the specific treatment strategy to the clinical and anatomical characteristics of each patient. Percutaneous treatments for acute PE and DVT represent valuable options in the therapeutic arsenal, offering enhanced outcomes in appropriately selected patients. Ongoing advancements in technology and technique, along with comprehensive clinical trials, are essential to further define the role and optimize the use of these interventions.
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Affiliation(s)
- Chiara Cavallino
- Cardiology Division, Sant’Andrea Hostpital, 13100 Vercelli, Italy; (M.F.); (M.A.); (L.M.); (E.B.); (F.R.); (F.U.)
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11
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Selleslag S, Bonne L, Rex S, Cools B. Percutaneous pulmonary aspiration thrombectomy in an adolescent fontan patient using a large-bore system. Catheter Cardiovasc Interv 2024; 104:272-276. [PMID: 38971969 DOI: 10.1002/ccd.31146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/10/2024] [Accepted: 06/29/2024] [Indexed: 07/08/2024]
Abstract
We describe the safe and effective percutaneous pulmonary thrombectomy in an 18-year-old female with a Fontan circulation using the FlowTriever® device (Inari Medical®, Irvine, US). Aspiration thrombectomy of both pulmonary arteries was performed using 24 and 16 F FlowTriever® catheters retrieving large amounts of thrombus material resulting in near total angiographic recanalization.
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Affiliation(s)
- Sébastien Selleslag
- Department of Radiology, Interventional Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Lawrence Bonne
- Department of Radiology, Interventional Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesia, University Hospitals Leuven, and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Björn Cools
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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12
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McFadden E, Ronco JJ, Finlayson G, Hadjivassiliou A, Ho S, Klass D, Legiehn G, Machan L, Parhar D, Romano K, Thiara S. Transvenous catheter-directed embolectomy for pulmonary embolism. Can J Anaesth 2024; 71:1163-1164. [PMID: 38987496 DOI: 10.1007/s12630-024-02797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/18/2024] [Accepted: 04/07/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- Eoin McFadden
- Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Juan J Ronco
- Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Gordon Finlayson
- Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Stephen Ho
- Department of Interventional Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Darren Klass
- Department of Interventional Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Gerald Legiehn
- Department of Interventional Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Lindsay Machan
- Department of Interventional Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Dennis Parhar
- Department of Interventional Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kali Romano
- Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Sonny Thiara
- Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada
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13
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Moriarty JM, Dohad SY, Schiro BJ, Tamaddon H, Heithaus RE, Iliadis EA, Dexter DJ, Shavelle DM, Leal SRN, Attallah AS, West FM, Keeling WB, Sharp ASP, Weinberg I. Clinical, Functional, and Quality-of-Life Outcomes after Computer Assisted Vacuum Thrombectomy for Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study. J Vasc Interv Radiol 2024; 35:1154-1165.e6. [PMID: 38729421 DOI: 10.1016/j.jvir.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/15/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE To report the first interim analysis of the STRIKE-PE study, evaluating the safety and effectiveness of computer assisted vaccum thrombectomy (CAVT) for the treatment of acute pulmonary embolism (PE). MATERIALS AND METHODS This 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 CAVT using the Indigo Aspiration 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. RESULTS The first 150 consecutive patients were treated with 12F 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 score and QoL measures, and the New York Heart Association class distribution returned to that reported before the index PE. CONCLUSIONS Interim results from the STRIKE-PE study demonstrate a significant reduction in pulmonary artery pressure and RV/LV ratio, a median thrombectomy time of 33.5 minutes, a composite MAE rate of 2.7%, and significant improvements in 90-day functional and QoL outcomes.
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Affiliation(s)
- John M Moriarty
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California.
| | - Suhail Y Dohad
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Brian J Schiro
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Houman Tamaddon
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Robert E Heithaus
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Elias A Iliadis
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - David J Dexter
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - David M Shavelle
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Silvio R N Leal
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Antonious S Attallah
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Frances M West
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - W Brent Keeling
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Andrew S P Sharp
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Ido Weinberg
- Department of Interventional Radiology, David Geffin School of Medicine, University of California Los Angeles, Los Angeles, California
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14
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Gunaga S, Smythe D, Shearer N, Hashem M, Al‐Hage A. Man with convulsive syncope. J Am Coll Emerg Physicians Open 2024; 5:e13249. [PMID: 39104917 PMCID: PMC11299247 DOI: 10.1002/emp2.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/02/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Satheesh Gunaga
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Emergency MedicineEnvision HealthcareAnn ArborMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
| | - Dennis Smythe
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
| | - Nathaniel Shearer
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
| | - Mustafa Hashem
- Department of Internal MedicineDivision of CardiologyHenry Ford Wyandotte HospitalWyandotteMichiganUSA
| | - Abe Al‐Hage
- Department of Emergency Medicine and Graduate Medical EducationHenry Ford Wyandotte HospitalWyandotteMichiganUSA
- Department of Emergency MedicineEnvision HealthcareAnn ArborMichiganUSA
- Department of Osteopathic Medical SpecialtiesMichigan State University College of Osteopathic MedicineEast LansingMichiganUSA
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15
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Leiva O, Yang EH, Rosovsky RP, Alviar C, Bangalore S. In-hospital and readmission outcomes of patients with cancer admitted for pulmonary embolism treated with or without catheter-based therapy. Int J Cardiol 2024; 408:132165. [PMID: 38750964 DOI: 10.1016/j.ijcard.2024.132165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Cancer patients are at risk of pulmonary embolism (PE). Catheter-based therapies (CBT) are novel reperfusion options for PE though data in patients with cancer is lacking. STUDY DESIGN AND METHODS Patients with intermediate- or high-risk PE were identified using the National Readmission Database (NRD) from 2017 to 2020. Primary outcome were in-hospital death and 90-day readmission. Secondary outcomes were in-hospital bleeding, 90-day readmission for venous thromboembolism (VTE)-related or right heart failure-related reasons and bleeding. Propensity scores were estimated using logistic regression and inverse-probability treatment weighting (IPTW) was utilized to compare outcomes between CBT and no CBT as well as CBT versus systemic thrombolysis. RESULTS A total of 7785 patients were included (2511 with high-risk PE) of whom 1045 (13.4%) were managed with CBT. After IPTW, CBT was associated with lower rates of index hospitalization death (OR 0.89, 95% CI 0.83-0.96) and 90-day readmission (HR 0.75, 95% CI 0.69-0.81) but higher rates of in-hospital bleeding (OR 1.11, 95% CI 1.03-1.20) which was predominantly post-procedural bleeding. CBT was associated with lower risk of major bleeding (20.8% vs 24.8%; OR 0.80, 95% CI 0.68-0.94) compared with systemic thrombolysis. INTERPRETATION Among patients with cancer with intermediate or high-risk PE, CBT was associated with lower in-hospital death and 90-day readmission. CBT was also associated with decreased risk of index hospitalization major bleeding compared with systemic thrombolysis. Prospective, randomized trials with inclusion of patients with cancer are needed to confirm these findings.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Rachel P Rosovsky
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Carlos Alviar
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sripal Bangalore
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America.
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16
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Kilkenny K, Frishman W. Venous Thromboembolism in Pregnancy: A Review of Diagnosis, Management, and Prevention. Cardiol Rev 2024:00045415-990000000-00306. [PMID: 39051770 DOI: 10.1097/crd.0000000000000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism, is a leading cause of maternal morbidity and mortality worldwide. Physiological changes that occur in a normal pregnancy increase the risk for VTE by 4-5-fold in the antepartum period and 30-60-fold in the immediate postpartum period. Compressive ultrasonography is the diagnostic test of choice for deep vein thrombosis. Both ventilation/perfusion scanning and computed tomography pulmonary angiography can reliably diagnose pulmonary embolism. Anticoagulation for a minimum of 3 months, typically with low molecular weight heparin, is the treatment of choice for pregnancy-associated VTE (PA-VTE). Despite the significant societal burden and potentially devastating consequences, there is a paucity of data surrounding the prevention of PA-VTE, resulting in major variations between international guidelines. This review will summarize the current recommendations for diagnosis, management, and prevention of PA-VTE.
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Affiliation(s)
- Katherine Kilkenny
- From the Department of Medicine, New York Presbyterian-Weill Cornell Medicine, New York, NY
- Department of Medicine, New York Medical College, School of Medicine, Valhalla, NY
| | - William Frishman
- Department of Medicine, New York Medical College, School of Medicine, Valhalla, NY
- Department of Medicine, Westchester Medical Center, Valhalla, NY
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17
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Mentzel LA, Shahidi P, Blazek S, Sulimov D, Thiele H, Fengler K. Clinical Outcome Using Different Catheter Interventional Treatment Modalities in High-Risk Pulmonary Artery Embolism. J Cardiovasc Dev Dis 2024; 11:228. [PMID: 39057648 PMCID: PMC11277428 DOI: 10.3390/jcdd11070228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND For patients with high-risk pulmonary artery embolism (PE), catheter-directed therapies pose a viable alternative treatment option to systemic thrombolysis or anticoagulation. Right now, there are multiple devices available which have been proven to be safe and effective in lower-risk settings. There is, however, little data comparing their efficacies in high-risk PE. METHODS We performed a retrospective, single-center study on patients with high-risk PE undergoing catheter interventional treatment. Patients receiving large-bore catheter thrombectomy were compared to patients receiving alternative treatment forms. RESULTS Of the 20 patients included, 9 received large-bore thrombectomy, and 11 received alternative interventional treatments. While the baseline characteristics were comparable between the two groups, periprocedural and in-hospital mortality tended to be significantly lower with large-bore thrombectomy when compared to other treatment forms (0 vs. 55% and 33 vs. 82%, p = 0.07 and 0.01, respectively). CONCLUSIONS In this small, retrospective study, large-bore thrombectomy was associated with lower mortality as compared to alternative treatment forms. Future prospective research is needed to corroborate these findings.
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Affiliation(s)
| | | | | | | | | | - Karl Fengler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany; (L.A.M.); (P.S.); (S.B.); (D.S.); (H.T.)
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18
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Pandya V, Chandra AA, Scotti A, Assafin M, Schenone AL, Latib A, Slipczuk L, Khaliq A. Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature. J Clin Med 2024; 13:3984. [PMID: 38999548 PMCID: PMC11242386 DOI: 10.3390/jcm13133984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, with varying presentations and management challenges. Traditional treatment approaches often differ, particularly for submassive/intermediate-risk PEs, because of the lack of clear guidelines and comparative data on treatment efficacy. The introduction of pulmonary embolism response teams (PERTs) aims to standardize and improve outcomes in acute PE management through multidisciplinary collaboration. This review examines the conception, evolution, and operational mechanisms of PERTs while providing a critical analysis of their implementation and efficacy using retrospective trials and recent randomized trials. The study also explores the integration of advanced therapeutic devices and treatment protocols facilitated by PERTs. PERT programs have significantly influenced the management of both massive and submassive PEs, with notable improvements in clinical outcomes such as decreased mortality and reduced length of hospital stay. The utilization of advanced therapies, including catheter-directed thrombolysis and mechanical thrombectomy, has increased under PERT guidance. Evidence from various studies, including those from the National PERT Consortium, underscores the benefits of these multidisciplinary teams in managing complex PE cases, despite some studies showing no significant difference in mortality. PERT programs have demonstrated potentials to reduce morbidity and mortality, streamlining the use of healthcare resources and fostering a model of sustainable practice across medical centers. PERT program implementation appears to have improved PE treatment protocols and innovated advanced therapy options, which will be further refined as they are employed in clinical practice. The continued expansion of the capabilities of PERTs and the forthcoming results from ongoing randomized trials are expected to further define and optimize management protocols for acute PEs.
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Affiliation(s)
| | | | | | | | | | | | | | - Asma Khaliq
- Division of Cardiology, Montefiore Health System, Albert Einstein College of Medicine, 111 E 210TH ST, Bronx, NY 10467, USA; (V.P.)
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19
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Rush B, Ziegler J, Dyck S, Dhaliwal S, Mooney O, Lother S, Celi LA, Mendelson AA. Disparities in access to and timing of interventional therapies for pulmonary embolism across the United States. J Thromb Haemost 2024; 22:1947-1955. [PMID: 38554934 DOI: 10.1016/j.jtha.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/20/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Interventional therapies (ITs) are an emerging treatment modality for pulmonary embolism (PE); however, the degree of racial, sex-based, and sociodemographic disparities in access and timing is unknown. OBJECTIVES To investigate barriers to access and timing of ITs for PE across the United States. METHODS A retrospective cohort study utilizing the Nationwide Inpatient Sample from 2016-2020 included adult patients with PE. The use of ITs (mechanical thrombectomy and catheter-directed thrombolysis) was identified via International Classification of Diseases 10th revision codes. Early IT was defined as procedure performed within the first 2 days after admission. RESULTS A total of 27 805 273 records from the 2016-2020 Nationwide Inpatient Sample database were examined. There were 387 514 (1.4%) patients with PE, with 14 249 (3.6%) of them having undergone IT procedures (11 115 catheter-directed thrombolysis, 2314 thrombectomy, and 780 both procedures). After multivariate adjustment, factors associated with less use of IT included Black race (odds ratio [OR], 0.90; 95% CI, 0.86-0.94; P < .01), Hispanic race (OR, 0.73; 95% CI, 0.68-0.79; P < .01), female sex (OR, 0.88; 95% CI, 0.85-0.91; P < .01), treatment in a rural hospital (OR, 0.49; 95% CI, 0.44-0.54; P < .01), and lack of private insurance (Medicare OR, 0.77; 95% CI, 0.73-0.80; P < .01; Medicaid OR, 0.65; 95% CI, 0.61-0.69; P < .01; no coverage OR, 0.87; 95% CI, 0.82-0.93; P < .01). Among the patients who received IT, 11 315 (79%) procedures were conducted within 2 days of admission and 2934 (21%) were delayed. Factors associated with delayed procedures included Black race (OR, 1.12; 95% CI, 1.01-1.26; P = .04), Hispanic race (OR, 1.52; 95% CI, 1.28-1.80; P < .01), weekend admission (OR, 1.37; 95% CI, 1.25-1.51; P < .01), Medicare coverage (OR, 1.24; 95% CI, 1.10-1.40; P < .01), and Medicaid coverage (OR, 1.29; 95% CI, 1.12-1.49; P < .01). CONCLUSION Significant racial, sex-based, and geographic barriers exist in overall access to IT for PE in the United States.
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Affiliation(s)
- Barret Rush
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Jennifer Ziegler
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Dyck
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Surinder Dhaliwal
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Owen Mooney
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sylvain Lother
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leo Anthony Celi
- Harvard Medical School, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Asher A Mendelson
- Section of Critical Care Medicine, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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20
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Tébar D, Jurado-Román A, Jiménez-Valero S, Galeote G, Gonzálvez A, Rivero B, García A, Añón Elizalde JM, Lorenzo A, Fernández Capitán C, Torres R, Soto C, Alcolea S, Rosillo S, Caro Codón J, Arbas E, Tejera F, Plaza I, Boscá L, Moreno R. Percutaneous pulmonary thrombectomy with aspiration catheters in patients with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00558-X. [PMID: 38960828 DOI: 10.1016/j.carrev.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/25/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND High-risk Pulmonary Embolism (PE) mortality remains very high. Systemic thrombolysis is effective but carries significant complications and contraindications related to the hemorrhagic risk. Percutaneous thrombectomy using aspiration catheters may be an alternative in patients with a high bleeding risk. OBJECTIVE This study aimed to evaluate the results of catheter-directed thrombectomy using aspiration dedicated catheters in patients with high-risk PE and absolute contraindication to systemic thrombolysis, with specific focus on procedural success, safety, and in-hospital outcomes. METHODS A prospective study enrolled all consecutive patients diagnosed with high-risk pulmonary embolism and absolute contraindication to systemic thrombolysis, who underwent percutaneous pulmonary thrombectomy using dedicated aspiration catheters. The study documented the effectiveness and complications of the procedure, as well as patient outcomes at discharge and during the follow-up period. RESULTS Thirteen patients underwent percutaneous pulmonary thrombectomy using aspiration dedicated catheters. The procedure was successful for all patients, resulting in hemodynamic and respiratory improvement within the first 24 h. No deaths attributable to cardiovascular or respiratory causes occurred during admission or follow-up. Furthermore, no serious adverse events or complications were reported during the procedure or hospitalization. CONCLUSIONS Percutaneous pulmonary thrombectomy with dedicated aspiration catheters in patients with high-risk pulmonary embolism and contraindications to systemic thrombolysis was associated with excellent clinical results and low rate of complications.
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Affiliation(s)
- Daniel Tébar
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain.
| | - Alfonso Jurado-Román
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Santiago Jiménez-Valero
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Guillermo Galeote
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Ariana Gonzálvez
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Borja Rivero
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Andoni García
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | | | - Alicia Lorenzo
- Thromboembolic Disease Unit, Internal Medicine. La Paz University Hospital, Madrid, Spain
| | | | - Rosario Torres
- Emergency Department, La Paz University Hospital, Madrid, Spain
| | - Clara Soto
- Pulmonary Hypertension Unit, La Paz University Hospital, Madrid, Spain
| | - Sergio Alcolea
- Pulmonary Hypertension Unit, La Paz University Hospital, Madrid, Spain
| | - Sandra Rosillo
- Cardiac Intensive Care Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Juan Caro Codón
- Cardiac Intensive Care Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Emilio Arbas
- Cardiac Intensive Care Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Fernando Tejera
- Intensive Care Unit, Infanta Cristina University Hospital, Madrid, Spain
| | - Ignacio Plaza
- Cardiology Department, Infanta Sofia University Hospital, Madrid, Spain
| | - Lisardo Boscá
- Hospital La Paz Research Foundation (IdiPAZ), Madrid, Spain; Network Center for Cardiovascular Diseases Research (CIBERcv), Spain; Sols-Morreale Biomedical Research Institute (CSIC-UAM), Spain; Autonomous University of Madrid, Madrid, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain; Hospital La Paz Research Foundation (IdiPAZ), Madrid, Spain
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21
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Ito WD. [Interventional therapy of pulmonary embolism - update]. Dtsch Med Wochenschr 2024; 149:679-683. [PMID: 38781990 DOI: 10.1055/a-2133-8319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
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.
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Affiliation(s)
- Wulf D Ito
- Herz-und Gefäßzentrum Oberallgäu-Kempten, Klinikverbund Allgäu gGmbH, Immenstadt
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22
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Monteleone P, Patel A, Paul J. Evidence-Based Update on Transcatheter Therapies for Pulmonary Embolism. Curr Cardiol Rep 2024; 26:475-482. [PMID: 38656585 DOI: 10.1007/s11886-024-02060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Pulmonary embolism (PE) remains a leading cause of cardiovascular morbidity and mortality. Multiple new therapies are in development and under study to improve our contemporary care of patients with PE. We review and compare here these novel therapeutics and technologies. RECENT FINDINGS Multiple novel therapeutic devices have been developed and are under active study. This work has advanced the care of patients with intermediate and high-risk PE. Novel therapies are improving care of complex PE patients. These have inspired large multicenter international randomized controlled trials that are actively recruiting patients to advance the care of PE. These studies will work towards advancing guidelines for clinical care of patients with PE.
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Affiliation(s)
- Peter Monteleone
- Department of Medicine, University of Texas at Austin Dell School of Medicine, Austin, USA.
- Ascension Texas Cardiovascular, Austin, TX, USA.
| | - Akash Patel
- Department of Medicine, University of Texas at Austin Dell School of Medicine, Austin, USA
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23
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Kim S, Kim M, Kodra A. Risks and Benefits of Device-Assisted Treatment of Pulmonary Embolism. Int J Angiol 2024; 33:101-106. [PMID: 38846990 PMCID: PMC11152619 DOI: 10.1055/s-0044-1782535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Pulmonary embolism (PE) is a common disease associated with significant morbidity and mortality. Despite the familiarity with this disease, the best treatment remains undefined. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis, or surgery. However, the debate over pharmacologic versus mechanical treatment of acute PE reared up again with the advent of user-friendly mechanical and aspiration thrombectomy technologies. This is especially true for submassive PE, which is an area for potential growth both for understanding the pathophysiology of the disease process and management. Multiple devices are available for treatment of PE. Understanding the risks and benefits of each device is paramount in the complex management of PE.
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Affiliation(s)
- Sofia Kim
- Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
| | - Michael Kim
- Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
| | - Arber Kodra
- Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
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24
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Glazier HA, Kaki A. Role of Extracorporeal Membrane Oxygenation in the Treatment of Massive Pulmonary Embolism. Int J Angiol 2024; 33:107-111. [PMID: 38846997 PMCID: PMC11152616 DOI: 10.1055/s-0044-1782658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Massive/high-risk pulmonary embolism (PE) is associated with a 30-day mortality rate of approximately 65%. In searching for strategies that may make a dent on this dismal mortality rate, investigators have, over the last decade, shown renewed interest in the potential beneficial role of venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) in the treatment of patients with high-risk PE. There is a dearth of high-quality evidence regarding the value of ECMO in the treatment of massive PE. Studies examining this issue have generally been retrospective, often single center and frequently with small patient numbers. Moreover, these reported studies are not matched with appropriate controls, and, accordingly, it is difficult to regulate for inherent treatment bias. Not surprisingly, there are no randomized controlled trials examining the value of ECMO in the treatment of massive PE, as such trials would pose formidable feasibility challenges. Over the past several years, there has been increasing support for upfront use of V-A ECMO in the treatment of massive PE, when it is complicated by cardiac arrest. In those patients without cardiac arrest, but who have contraindications for thrombolysis, V-A ECMO combined with anticoagulation may be used to stabilize the patient. If after 3 to 5 days, such patients demonstrate persistent right ventricular dysfunction, embolectomy (either surgical or catheter based) should be performed. Well-designed, multicenter, prospective studies are urgently needed to better define the role of V-A ECMO in the treatment of patients with massive PE.
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Affiliation(s)
- Hugh A. Glazier
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Amir Kaki
- Division of Cardiology, St. John University Hospital, Detroit, Michigan
- Department of Medicine, Wayne State University, Detroit, Michigan
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25
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Chopard R, Morillo R, Meneveau N, Jiménez D. Integration of Extracorporeal Membrane Oxygenation into the Management of High-Risk Pulmonary Embolism: An Overview of Current Evidence. Hamostaseologie 2024; 44:182-192. [PMID: 38531394 DOI: 10.1055/a-2215-9003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
High-risk pulmonary embolism (PE) refers to a large embolic burden causing right ventricular failure and hemodynamic instability. It accounts for approximately 5% of all cases of PE but contributes significantly to overall PE mortality. Systemic thrombolysis is the first-line revascularization therapy in high-risk PE. Surgical embolectomy or catheter-directed therapy is recommended in patients with an absolute contraindication to systemic thrombolysis. Extracorporeal membrane oxygenation (ECMO) provides respiratory and hemodynamic support for the most critically ill PE patients with refractory cardiogenic shock or cardiac arrest. The complex management of these individuals requires urgent yet coordinated multidisciplinary care. In light of existing evidence regarding the utility of ECMO in the management of high-risk PE patients, a number of possible indications for ECMO utilization have been suggested in the literature. Specifically, in patients with refractory cardiac arrest, resuscitated cardiac arrest, or refractory shock, including in cases of failed thrombolysis, venoarterial ECMO (VA-ECMO) should be considered, either as a bridge to percutaneous or surgical embolectomy or as a bridge to recovery after surgical embolectomy. We review here the current evidence on the use of ECMO as part of the management strategy for the highest-risk presentations of PE and summarize the latest data in this indication.
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Affiliation(s)
- Romain Chopard
- Department of Cardiology, University Hospital Besançon, Besançon, France
- SINERGIES, University of Franche-Comté, Besançon, France
- F-CRIN, INNOVTE network, France
| | - Raquel Morillo
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Medicine Department, Universidad de Alcalá, (IRYCIS) Madrid, Spain
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Besançon, Besançon, France
- SINERGIES, University of Franche-Comté, Besançon, France
- F-CRIN, INNOVTE network, France
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Medicine Department, Universidad de Alcalá, (IRYCIS) Madrid, Spain
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26
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Ellauzi R, Erdem S, Salam MF, Kumar A, Aggarwal V, Koenig G, Aronow HD, Basir MB. Mechanical Circulatory Support Devices in Patients with High-Risk Pulmonary Embolism. J Clin Med 2024; 13:3161. [PMID: 38892871 PMCID: PMC11172824 DOI: 10.3390/jcm13113161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/22/2024] [Accepted: 05/08/2024] [Indexed: 06/21/2024] Open
Abstract
Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients with high-risk and massive pulmonary embolisms. In particular, we focus on the role of mechanical circulatory support devices and their possible therapeutic benefits in patients who are unresponsive to standard therapeutic options. Moreover, attention is given to device selection criteria, weaning protocols, and complication mitigation strategies. Finally, we underscore the necessity for more comprehensive studies to corroborate the benefits and safety of MCS devices in PE management.
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Affiliation(s)
- Rama Ellauzi
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Saliha Erdem
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI 48202, USA;
| | - Mohammad Fahad Salam
- Department of Internal Medicine, Michigan State University, East Lansing, MI 48502, USA;
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH 44307, USA;
| | - Vikas Aggarwal
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Gerald Koenig
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Herbert D. Aronow
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
| | - Mir Babar Basir
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI 48202, USA; (V.A.); (H.D.A.)
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27
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Sharp A, Mahfoud F. Contemporary outcomes in patients hospitalized with pulmonary embolism: what can we learn from observational data? Eur Heart J 2024:ehae263. [PMID: 38805685 DOI: 10.1093/eurheartj/ehae263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Affiliation(s)
- Andrew Sharp
- Department of Cardiology, University Hospital of Wales, and Cardiff University, Heath Park Way, Cardiff CF14 4XW, United Kingdom
| | - Felix Mahfoud
- Clinic of Cardiology, Angiology and Internal Medicine, University Hospital Homburg, Saarland University, Saarbrücken, Germany
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
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Rozenbaum Z. Revisiting Systemic Thrombolysis in Acute Pulmonary Embolism. JACC. ADVANCES 2024; 3:100923. [PMID: 38939641 PMCID: PMC11198091 DOI: 10.1016/j.jacadv.2024.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Zach Rozenbaum
- Department of Cardiology, Tulane University, New Orleans, Louisiana, USA
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Rouleau SG, Casey SD, Kabrhel C, Vinson DR, Long B. Management of high-risk pulmonary embolism in the emergency department: A narrative review. Am J Emerg Med 2024; 79:1-11. [PMID: 38330877 DOI: 10.1016/j.ajem.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND High-risk pulmonary embolism (PE) is a complex, life-threatening condition, and emergency clinicians must be ready to resuscitate and rapidly pursue primary reperfusion therapy. The first-line reperfusion therapy for patients with high-risk PE is systemic thrombolytics (ST). Despite consensus guidelines, only a fraction of eligible patients receive ST for high-risk PE. OBJECTIVE This review provides emergency clinicians with a comprehensive overview of the current evidence regarding the management of high-risk PE with an emphasis on ST and other reperfusion therapies to address the gap between practice and guideline recommendations. DISCUSSION High-risk PE is defined as PE that causes hemodynamic instability. The high mortality rate and dynamic pathophysiology of high-risk PE make it challenging to manage. Initial stabilization of the decompensating patient includes vasopressor administration and supplemental oxygen or high-flow nasal cannula. Primary reperfusion therapy should be pursued for those with high-risk PE, and consensus guidelines recommend the use of ST for high-risk PE based on studies demonstrating benefit. Other options for reperfusion include surgical embolectomy and catheter directed interventions. CONCLUSIONS Emergency clinicians must possess an understanding of high-risk PE including the clinical assessment, pathophysiology, management of hemodynamic instability and respiratory failure, and primary reperfusion therapies.
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Affiliation(s)
- Samuel G Rouleau
- Department of Emergency Medicine, UC Davis Health, University of California, Davis, Sacramento, CA, United States of America.
| | - Scott D Casey
- Kaiser Permanente Northern California Division of Research, The Permanente Medical Group, Oakland, CA, United States of America; Department of Emergency Medicine, Kaiser Permanente Vallejo Medical Center, Vallejo, CA, United States of America.
| | - Christopher Kabrhel
- Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - David R Vinson
- Kaiser Permanente Northern California Division of Research, The Permanente Medical Group, Oakland, CA, United States of America; Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, CA, United States of America.
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, United States of America.
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Ley L, Messmer F, Vaisnora L, Ghofrani HA, Bandorski D, Kostrzewa M. Electrocardiographic Changes after Endovascular Mechanical Thrombectomy in a Patient with Pulmonary Embolism-A Case Report and Literature Review. J Clin Med 2024; 13:2548. [PMID: 38731076 PMCID: PMC11084833 DOI: 10.3390/jcm13092548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
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.
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Affiliation(s)
- Lukas Ley
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany
| | - Florian Messmer
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
| | - Lukas Vaisnora
- Department of Cardiology, Baden Cantonal Hospital, 5404 Baden, Switzerland;
| | | | - Dirk Bandorski
- Faculty of Medicine, Semmelweis University Campus Hamburg, 20099 Hamburg, Germany;
| | - Michael Kostrzewa
- Department of Radiology, Baden Cantonal Hospital, 5404 Baden, Switzerland; (F.M.); (M.K.)
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Zhang RS, Alviar CL, Yuriditsky E, Alam U, Zhang PS, Elbaum L, Grossman K, Singh A, Maqsood MH, Greco AA, Postelnicu R, Mukherjee V, Horowitz J, Keller N, Bangalore S. Percutaneous mechanical thrombectomy in acute pulmonary embolism: Outcomes from a safety-net hospital. Catheter Cardiovasc Interv 2024. [PMID: 38577945 DOI: 10.1002/ccd.31024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Our study aims to present clinical outcomes of mechanical thrombectomy (MT) in a safety-net hospital. METHODS This is a retrospective study of intermediate or high-risk pulmonary embolism (PE) patients who underwent MT between October 2020 and May 2023. The primary outcome was 30-day mortality. RESULTS Among 61 patients (mean age 57.6 years, 47% women, 57% Black) analyzed, 12 (19.7%) were classified as high-risk PE, and 49 (80.3%) were intermediate-risk PE. Of these patients, 62.3% had Medicaid or were uninsured, 50.8% lived in a high poverty zip code. The prevalence of normotensive shock in intermediate-risk PE patients was 62%. Immediate hemodynamic improvements included 7.4 mmHg mean drop in mean pulmonary artery pressure (-21.7%, p < 0.001) and 93% had normalization of their cardiac index postprocedure. Thirty-day mortality for the entire cohort was 5% (3 patients) and 0% when restricted to the intermediate-risk group. All 3 patients who died at 30 days presented with cardiac arrest. There were no differences in short-term mortality based on race, insurance type, citizenship status, or socioeconomic status. All-cause mortality at most recent follow up was 13.1% (mean follow up time of 13.4 ± 8.5 months). CONCLUSION We extend the findings from prior studies that MT demonstrates a favorable safety profile with immediate improvement in hemodynamics and a low 30-day mortality in patients with acute PE, holding true even with relatively higher risk and more vulnerable population within a safety-net hospital.
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Affiliation(s)
- Robert S Zhang
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Carlos L Alviar
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Eugene Yuriditsky
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Usman Alam
- Department of Medicine, New York University, New York City, New York, USA
| | - Peter S Zhang
- Department of Medicine, New York University, New York City, New York, USA
| | - Lindsay Elbaum
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Kelsey Grossman
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Arushi Singh
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Muhammad H Maqsood
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Allison A Greco
- Division of Pulmonary Critical Care, and Sleep Medicine, New York University, New York City, New York, USA
| | - Radu Postelnicu
- Division of Pulmonary Critical Care, and Sleep Medicine, New York University, New York City, New York, USA
| | - Vikramjit Mukherjee
- Division of Pulmonary Critical Care, and Sleep Medicine, New York University, New York City, New York, USA
| | - James Horowitz
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Norma Keller
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
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Leiva O, Alviar C, Khandhar S, Parikh SA, Toma C, Postelnicu R, Horowitz J, Mukherjee V, Greco A, Bangalore S. Catheter-based therapy for high-risk or intermediate-risk pulmonary embolism: death and re-hospitalization. Eur Heart J 2024:ehae184. [PMID: 38573048 DOI: 10.1093/eurheartj/ehae184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND AIMS Catheter-based therapies (CBTs) have been developed as a treatment option in patients with pulmonary embolism (PE). There remains a paucity of data to inform decision-making in patients with intermediate-risk or high-risk PE. The aim of this study was to characterize in-hospital and readmission outcomes in patients with intermediate-risk or high-risk PE treated with vs. without CBT in a large retrospective registry. METHODS Patients hospitalized with intermediate-risk or high-risk PE were identified using the 2017-20 National Readmission Database. In-hospital outcomes included death and bleeding and 30- and 90-day readmission outcomes including all-cause, venous thromboembolism (VTE)-related and bleeding-related readmissions. Inverse probability of treatment weighting (IPTW) was utilized to compare outcomes between CBT and no CBT. RESULTS A total of 14 903 [2076 (13.9%) with CBT] and 42 829 [8824 (20.6%) with CBT] patients with high-risk and intermediate-risk PE were included, respectively. Prior to IPTW, patients with CBT were younger and less likely to have cancer and cardiac arrest, receive systemic thrombolysis, or be on mechanical ventilation. In the IPTW logistic regression model, CBT was associated with lower odds of in-hospital death in high-risk [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.80-0.87] and intermediate-risk PE (OR 0.76, 95% CI 0.70-0.83). Patients with high-risk PE treated with CBT were associated with lower risk of 90-day all-cause [hazard ratio (HR) 0.77, 95% CI 0.71-0.83] and VTE (HR 0.46, 95% CI 0.34-0.63) readmission. Patients with intermediate-risk PE treated with CBT were associated with lower risk of 90-day all-cause (HR 0.75, 95% CI 0.72-0.79) and VTE (HR 0.66, 95% CI 0.57-0.76) readmission. CONCLUSIONS Among patients with high-risk or intermediate-risk PE, CBT was associated with lower in-hospital death and 90-day readmission. Prospective, randomized trials are needed to confirm these findings.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
| | - Carlos Alviar
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
| | - Sameer Khandhar
- Division of Cardiology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sahil A Parikh
- Division of Cardiology, Columbia University Irving Medical School, New York-Presbyterian Hospital, New York, NY, USA
| | - Catalin Toma
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Radu Postelnicu
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, NY, USA
| | - James Horowitz
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
| | - Vikramjit Mukherjee
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, NY, USA
| | - Allison Greco
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, NY, USA
| | - Sripal Bangalore
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
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Finocchiaro S, Mauro MS, Rochira C, Spagnolo M, Laudani C, Landolina D, Mazzone PM, Agnello F, Ammirabile N, Faro DC, Imbesi A, Occhipinti G, Greco A, Capodanno D. Percutaneous interventions for pulmonary embolism. EUROINTERVENTION 2024; 20:e408-e424. [PMID: 38562073 PMCID: PMC10979388 DOI: 10.4244/eij-d-23-00895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/19/2024] [Indexed: 04/04/2024]
Abstract
Pulmonary embolism (PE) ranks as a leading cause of in-hospital mortality and the third most common cause of cardiovascular death. The spectrum of PE manifestations varies widely, making it difficult to determine the best treatment approach for specific patients. Conventional treatment options include anticoagulation, thrombolysis, or surgery, but emerging percutaneous interventional procedures are being investigated for their potential benefits in heterogeneous PE populations. These novel interventional techniques encompass catheter-directed thrombolysis, mechanical thrombectomy, and hybrid approaches combining different mechanisms. Furthermore, inferior vena cava filters are also available as an option for PE prevention. Such interventions may offer faster improvements in right ventricular function, as well as in pulmonary and systemic haemodynamics, in individual patients. Moreover, percutaneous treatment may be a valid alternative to traditional therapies in high bleeding risk patients and could potentially reduce the burden of mortality related to major bleeds, such as that of haemorrhagic strokes. Nevertheless, the safety and efficacy of these techniques compared to conservative therapies have not been conclusively established. This review offers a comprehensive evaluation of the current evidence for percutaneous interventions in PE and provides guidance for selecting appropriate patients and treatments. It serves as a valuable resource for future researchers and clinicians seeking to advance this field. Additionally, we explore future perspectives, proposing "percutaneous primary pulmonary intervention" as a potential paradigm shift in the field.
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Affiliation(s)
- Simone Finocchiaro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Maria Sara Mauro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Carla Rochira
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Marco Spagnolo
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Claudio Laudani
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Landolina
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Placido Maria Mazzone
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Federica Agnello
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Nicola Ammirabile
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Denise Cristiana Faro
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Antonino Imbesi
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Giovanni Occhipinti
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Antonio Greco
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico - San Marco", University of Catania, Catania, Italy
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Falsetti L, Guerrieri E, Zaccone V, Viticchi G, Santini S, Giovenali L, Lagonigro G, Carletti S, Gialluca Palma LE, Tarquinio N, Moroncini G. Cutting-Edge Techniques and Drugs for the Treatment of Pulmonary Embolism: Current Knowledge and Future Perspectives. J Clin Med 2024; 13:1952. [PMID: 38610717 PMCID: PMC11012374 DOI: 10.3390/jcm13071952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
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.
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Affiliation(s)
- Lorenzo Falsetti
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.F.)
| | - Emanuele Guerrieri
- Emergency Medicine Residency Program, Università Politecnica delle Marche, 60126 Ancona, Italy; (E.G.)
| | - Vincenzo Zaccone
- Internal and Subintensive Medicine, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Giovanna Viticchi
- Clinica di Neurologia, Dipartimento Scienze Cliniche e Molecolare, Università Politecnica delle Marche, 60126 Ancona, Italy
| | - Silvia Santini
- Emergency Medicine Residency Program, Università Politecnica delle Marche, 60126 Ancona, Italy; (E.G.)
| | - Laura Giovenali
- Emergency Medicine Residency Program, Università Politecnica delle Marche, 60126 Ancona, Italy; (E.G.)
| | - Graziana Lagonigro
- Emergency Medicine Residency Program, Università Politecnica delle Marche, 60126 Ancona, Italy; (E.G.)
| | - Stella Carletti
- Emergency Medicine Residency Program, Università Politecnica delle Marche, 60126 Ancona, Italy; (E.G.)
| | | | - Nicola Tarquinio
- Internal Medicine Department, INRCA-IRCCS Osimo-Ancona, 60027 Ancona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.F.)
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Zuin M, Becattini C, Piazza G. Early predictors of clinical deterioration in intermediate-high risk pulmonary embolism: clinical needs, research imperatives, and pathways forward. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:297-303. [PMID: 37967341 DOI: 10.1093/ehjacc/zuad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023]
Abstract
A subset of intermediate-high risk pulmonary embolism (PE) patients will suffer clinical deterioration in the early hours following the acute event. Current evidence-based guidelines for the management of acute PE have provided limited direction for identification of which intermediate-high risk PE patients will go on to develop haemodynamic decompensation. Furthermore, a paucity of data further hampers guideline recommendations regarding the optimal approach and duration of intensive monitoring, best methods to assess the early response to anticoagulation, and the ideal window for reperfusion therapy, if decompensation threatens. The aim of the present article is to identify the current unmet needs related to the early identification of intermediate-high risk PE patients at higher risk of clinical deterioration and mortality during the early hours after the acute cardiovascular event and suggest some potential strategies to further explore gaps in the literature.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Luigi Borsari, 46 - 44121 Ferrara, Italy
| | - Cecilia Becattini
- Department of Internal Medicine, Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Casey SD, Stubblefield WB, Luijten D, Klok FA, Westafer LM, Vinson DR, Kabrhel C. Addressing the rising trend of high-risk pulmonary embolism mortality: Clinical and research priorities. Acad Emerg Med 2024; 31:288-292. [PMID: 38129964 DOI: 10.1111/acem.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Deaths from high-risk pulmonary embolism (PE) appear to have increased in the US over the last decade. Modifiable risks contributing to this worrisome trend present opportunities for physicians, researchers, and healthcare policymakers to improve care. METHODS We sought to contextualize contemporary, high-risk PE epidemiology and examine clinical trials, quality improvement opportunities, and healthcare policy initiatives directed at reducing mortality. RESULTS We observed significant and modifiable excess mortality due to high-risk PE. We identified several opportunities to improve care including: (1) rapid translation of forthcoming data on reperfusion strategies into clinical practice; (2) improved risk stratification tools; (3) quality improvement initiatives to address presumptive anticoagulation practice gaps; and (3) adoption of health policy initiatives to establish pulmonary embolism response teams and address the social determinants of health. CONCLUSION Addressing knowledge and practice gaps in intermediate and high-risk PE management must be prioritized and informed by forthcoming high-quality data. Implementation efforts are needed to improve acute PE management and resolve treatment disparities.
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Affiliation(s)
- Scott D Casey
- Kaiser Permanente Division of Research, Oakland, California, USA
- The Kaiser Permanente CREST Network, Oakland, California, USA
- Department of Emergency Medicine, Kaiser Permanente Vallejo Medical Center, Vallejo, California, USA
| | - William B Stubblefield
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dieuwke Luijten
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medicine Center, Leiden, Netherlands
| | - Frederikus A Klok
- Department of Medicine-Thrombosis and Hemostasis, Leiden University Medicine Center, Leiden, Netherlands
| | - Lauren M Westafer
- Department of Emergency Medicine, UMASS Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Department of Healthcare Delivery and Population Science, UMASS Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - David R Vinson
- Kaiser Permanente Division of Research, Oakland, California, USA
- The Kaiser Permanente CREST Network, Oakland, California, USA
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California, USA
| | - Christopher Kabrhel
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Tébar Márquez D, Jurado-Román A, Galeote G, Jiménez-Valero S, García Muñoz A, Lorenzo Hernández A, Angélica Rivera Núñez M, Alcolea Batres S, Moreno R. Percutaneous Pulmonary Thrombectomy Beyond Acute Pulmonary Embolism: Removing Organized Thrombus in Subacute Massive Pulmonary Embolism. J Endovasc Ther 2024:15266028241233994. [PMID: 38385241 DOI: 10.1177/15266028241233994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
CLINICAL IMPACT Mechanical thrombectomy using a thromboaspiration catheter can be an effective alternative in the treatment of subacute pulmonary embolism.
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Affiliation(s)
- Daniel Tébar Márquez
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Alfonso Jurado-Román
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Guillermo Galeote
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | - Santiago Jiménez-Valero
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | | | | | - Sergio Alcolea Batres
- Pulmonary Hypertension Unit, Respiratory Medicine Unit, La Paz University Hospital, Madrid, Spain
| | - Raúl Moreno
- Interventional Cardiology Unit, Cardiology Department, La Paz University Hospital, Madrid, Spain
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Kobayashi T, Pugliese S, Sethi SS, Parikh SA, Goldberg J, Alkhafan F, Vitarello C, Rosenfield K, Lookstein R, Keeling B, Klein A, Gibson CM, Glassmoyer L, Khandhar S, Secemsky E, Giri J. Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism. J Am Coll Cardiol 2024; 83:35-43. [PMID: 38171708 DOI: 10.1016/j.jacc.2023.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown. OBJECTIVES This study sought to characterize the management of high-risk PE patients and identify factors associated with poor outcomes. METHODS A retrospective analysis of the PERT (Pulmonary Embolism Response Team) Consortium Registry was performed. Patients presenting with intermediate-risk PE, high-risk PE, and catastrophic PE (those with hemodynamic collapse) were identified. Patient characteristics were compared with chi-square testing for categorical covariates and Student's t-test for continuous covariates. Multivariable logistic regression was used to assess associations between clinical characteristics and outcomes in the high-risk population. RESULTS Of 5,790 registry patients, 2,976 presented with intermediate-risk PE and 1,442 with high-risk PE. High-risk PE patients were more frequently treated with advanced therapies than intermediate-risk PE patients (41.9% vs 30.2%; P < 0.001). In-hospital mortality (20.6% vs 3.7%; P < 0.001) and major bleeding (10.5% vs. 3.5%; P < 0.001) were more common in high-risk PE. Multivariable regression analysis demonstrated vasopressor use (OR: 4.56; 95% CI: 3.27-6.38; P < 0.01), extracorporeal membrane oxygenation use (OR: 2.86; 95% CI: 1.12-7.30; P = 0.03), identified clot-in-transit (OR: 2.26; 95% CI: 1.13-4.52; P = 0.02), and malignancy (OR: = 1.70; 95% CI: 1.13-2.56; P = 0.01) as factors associated with in-hospital mortality. Catastrophic PE patients (n = 197 [13.7% of high-risk PE patients]) had higher in-hospital mortality (42.1% vs 17.2%; P < 0.001) than those presenting with noncatastrophic high-risk PE. Extracorporeal membrane oxygenation (13.3% vs. 4.8% P < 0.001) and systemic thrombolysis (25% vs 11.3%; P < 0.001) were used more commonly in catastrophic PE. CONCLUSIONS In the largest analysis of high-risk PE patients to date, mortality rates were high with the worst outcomes among patients with hemodynamic collapse.
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Affiliation(s)
- Taisei Kobayashi
- Cardiovascular Medicine Division, Perelman School of Medicine. University of Pennsylvania, Philadelphia, Pennsylvania, USA; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania, USA
| | - Steven Pugliese
- Division of Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjum S Sethi
- Center for Interventional Cardiovascular Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Sahil A Parikh
- Center for Interventional Cardiovascular Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Joshua Goldberg
- Cardiothoracic Surgery Division, Westchester Medical Center, Westchester, New York, USA
| | - Fahad Alkhafan
- Boston Clinical Research Institute, Boston, Massachusetts, USA
| | - Clara Vitarello
- Boston Clinical Research Institute, Boston, Massachusetts, USA
| | - Kenneth Rosenfield
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Lookstein
- Department of Radiology, Mount Sinai Medical Center, New York, New York, USA
| | - Brent Keeling
- Division of Cardiothoracic Surgery, Emory University Hospital, Atlanta, Georgia, USA
| | | | - C Michael Gibson
- Boston Clinical Research Institute, Boston, Massachusetts, USA; Smith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Glassmoyer
- Cardiovascular Medicine Division, Perelman School of Medicine. University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sameer Khandhar
- Cardiovascular Medicine Division, Perelman School of Medicine. University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric Secemsky
- Smith Center for Cardiovascular Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jay Giri
- Cardiovascular Medicine Division, Perelman School of Medicine. University of Pennsylvania, Philadelphia, Pennsylvania, USA; Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, Philadelphia, Pennsylvania, USA.
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Tehrani BN, Batchelor WB, Spinosa D. High-Risk Acute Pulmonary Embolism: Where Do We Go From Here? J Am Coll Cardiol 2024; 83:44-46. [PMID: 38171709 DOI: 10.1016/j.jacc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Affiliation(s)
| | | | - David Spinosa
- Inova Schar Heart and Vascular, Falls Church, Virginia, USA; Fairfax Radiologic Consultants, Fairfax, Virginia, USA
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Horowitz JM, Jaber WA, Stegman B, Rosenberg M, Fanola C, Bhat AP, Gondi S, Castle J, Ahmed M, Brown MA, Amin R, Bisharat M, Butros P, DuCoffe A, Savin M, Pollak JS, Weinberg MD, Brancheau D, Toma C. Mechanical Thrombectomy for High-Risk Pulmonary Embolism: Insights From the US Cohort of the FLASH Registry. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101124. [PMID: 39131977 PMCID: PMC11307390 DOI: 10.1016/j.jscai.2023.101124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2024]
Abstract
Background Acute mortality for high-risk, or massive, pulmonary embolism (PE) is almost 30% even when treated using advanced therapies. This analysis assessed the safety and effectiveness of mechanical thrombectomy (MT) for high-risk PE. Methods The prospective, multicenter FlowTriever All-comer Registry for Patient Safety and Hemodynamics (FLASH) study is designed to evaluate real-world PE patient outcomes after MT with the FlowTriever System (Inari Medical). In this study, acute outcomes through 30 days were evaluated for the subset of patients with high-risk PE as determined by the sites and following European Society of Cardiology guidelines. An independent medical monitor adjudicated adverse events (AEs), including major AEs: device-related mortality, major bleeding, or intraprocedural device-related or procedure-related AEs. Results Of the 799 patients in the US cohort, 63 (7.9%) were diagnosed with high-risk PE; 30 (47.6%) patients showed a systolic blood pressure <90 mm Hg, 29 (46.0%) required vasopressors, and 4 (6.3%) experienced cardiac arrest. The mean age of patients with high-risk PE was 59.4 ± 15.6 years, and 34 (54.0%) were women. At baseline, 45 (72.6%) patients were tachycardic, 18 (54.5%) showed elevated lactate levels of ≥2.5 mM, and 21 (42.9%) demonstrated depressed cardiac index of <2 L/min/m2. Immediately after MT, heart rate improved to 93.5 ± 17.9 bpm. Twenty-five (42.4%) patients did not require an overnight stay in the intensive care unit, and no mortalities or major AEs occurred through 48 hours. Moreover, no mortalities occurred in 61 (96.8%) patients followed up through the 30-day visit. Conclusions In this cohort of 63 patients with high-risk PE, MT was safe and effective, with no acute mortalities reported. Further prospective data are needed in this population.
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Affiliation(s)
- James M. Horowitz
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | | | - Brian Stegman
- CentraCare Heart and Vascular Center, St. Cloud, Minnesota
| | - Michael Rosenberg
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Christina Fanola
- Department of Cardiology, University of Minnesota, Minneapolis, Minnesota
| | - Ambarish P. Bhat
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Missouri, Columbia, Missouri
| | | | - Jordan Castle
- Inland Imaging, Providence Sacred Heart, Spokane, Washington
| | - Mustafa Ahmed
- UAB Division of Cardiovascular Disease, Birmingham, Alabama
| | | | - Rohit Amin
- Ascension Sacred Heart Hospital Pensacola, Pensacola, Florida
| | | | - Paul Butros
- Inova Health System, Fairfax, Virginia
- Southpark Vascular Center, Colonial Heights, Virginia
| | | | - Michael Savin
- Section of Interventional Radiology, Department of Radiology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan
| | - Jeffrey S. Pollak
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Mitchell D. Weinberg
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Staten Island University Hospital, Staten Island, New York
| | | | - Catalin Toma
- University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania
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Ortega-Paz L, Bikdeli B. Endovascular Therapies for Pulmonary Embolism: A Landscape of Uncertainties and Opportunities. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101221. [PMID: 39131983 PMCID: PMC11307431 DOI: 10.1016/j.jscai.2023.101221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/21/2023] [Indexed: 08/13/2024]
Affiliation(s)
- Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women’s Hospital, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Yale/YNHH Center for Outcomes Research & Evaluation (CORE), New Haven, Connecticut
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Vedantham S. Massive Pulmonary Embolism: Optimizing Collaborative Care and Endovascular Therapy. Circ Cardiovasc Interv 2023; 16:e013536. [PMID: 37847769 PMCID: PMC10593506 DOI: 10.1161/circinterventions.123.013536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
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Arora S, Vallabhajosyula S, Aggarwal V, Basir MB, Kelly B, Atreya AR. Novel Risk Stratification and Hemodynamic Profiling in Acute Pulmonary Embolism: A Proposed Classification Inspired by Society for Cardiovascular Angiography and Intervention Shock Staging. Interv Cardiol Clin 2023; 12:e1-e20. [PMID: 38964819 DOI: 10.1016/j.iccl.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Treatment options for patients with acute pulmonary embolism (PE) and right ventricular shock (RVS) have grown exponentially. Therapy options include anticoagulation, systemic thrombolysis, catheter-based thrombolysis/ thrombectomy, and may include short-term mechanical circulatory support. However, the incidence of short-term morbidity and mortality has not changed despite the emergence of several advanced therapies in acute PE. This is possibly due to the inclusion of heterogenous populations in research studies without differentiation based on the acuity/severity of presentation. We propose a novel classification for PE-RVS to allow for standardizing appropriate therapy escalation and better communication of the severity among cardiovascular critical care, and emergency health care professionals.
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Affiliation(s)
- Sonali Arora
- Institute of Heart and Lung Transplant, Krishna Institute of Medical Sciences Hospitals, Secunderabad, Telangana, India
| | - Saraschandra Vallabhajosyula
- Section of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, RI, USA
| | - Vikas Aggarwal
- Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Mir B Basir
- Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Bryan Kelly
- Division of Pulmonary Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA; Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Auras R Atreya
- AIG Institute of Cardiac Sciences and Research, Gachibowli, Hyderabad, Telangana, India; Sciences and Research, Gachibowli, Hyderabad, Telangana, India.
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