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Luedemann WM, Zickler D, Kruse J, Koerner R, Lenk J, Erxleben C, Torsello GF, Fehrenbach U, Jonczyk M, Guenther RW, De Bucourt M, Gebauer B. Percutaneous Large-Bore Pulmonary Thrombectomy with the FlowTriever Device: Initial Experience in Intermediate-High and High-Risk Patients. Cardiovasc Intervent Radiol 2023; 46:35-42. [PMID: 36175655 PMCID: PMC9521880 DOI: 10.1007/s00270-022-03266-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/23/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This retrospective cohort study investigates outcomes of patients with intermediate-high and high-risk pulmonary embolism (PE) who were treated with transfemoral mechanical thrombectomy (MT) using the large-bore Inari FlowTriever aspiration catheter system. MATERIAL AND METHODS Twenty-seven patients (mean age 56.1 ± 15.3 years) treated with MT for PE between 04/2021 and 11/2021 were reviewed. Risk stratification was performed according to European Society of Cardiology (ESC) guidelines. Clinical and hemodynamic characteristics before and after the procedure were compared with the paired Student's t test, and duration of hospital stay was analyzed with the Kaplan-Meier estimator. Procedure-related adverse advents were assessed. RESULTS Of 27 patients treated, 18 were classified as high risk. Mean right-to-left ventricular ratio on baseline CT was 1.7 ± 0.6. After MT, a statistically significant reduction in mean pulmonary artery pressures from 35.9 ± 9.6 to 26.1 ± 9.0 mmHg (p = 0.002) and heart rates from 109.4 ± 22.5 to 82.8 ± 13.8 beats per minute (p < 0.001) was achieved. Two patients died of prolonged cardiogenic shock. Three patients died of post-interventional complications of which a paradoxical embolism can be considered related to MT. One patient needed short cardiopulmonary resuscitation during the procedure due to clot displacement. Patients with PE as primary driver of clinical instability had a median intensive care unit (ICU) stay of 2 days (0.5-3.5 days). Patients who developed PE as a complication of an underlying medical condition spent 11 days (9.5-12.5 days) in the ICU. CONCLUSION In this small study population of predominantly high-risk PE patients, large-bore MT without adjunctive thrombolysis was feasible with an acceptable procedure-related complication rate.
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Affiliation(s)
- W. M. Luedemann
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - D. Zickler
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Kruse
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - R. Koerner
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - J. Lenk
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Erxleben
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - G. F. Torsello
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - U. Fehrenbach
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M. Jonczyk
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - R. W. Guenther
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M. De Bucourt
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - B. Gebauer
- grid.6363.00000 0001 2218 4662Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Peuker C, Polzin L, Ochsenreither S, De Bucourt M, Leyvraz S, Keilholz U, Joussen A, Eucker J. Retrospective analysis of the treatment of metastatic uveal melanoma comparing systemic chemotherapy and transarterial chemoembolization. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy289.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Streitparth F, De Bucourt M, Hartwig T, Leidenberger T, Walter T, Maurer M, Renz D, Stelter L, Wiener E, Hamm B, Teichgräber U. MR-gesteuerte lumbosakrale periradikuläre Infiltrationstherapie im offenen 1.0 Tesla MRT - klinisches Outcome. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Maurer MH, Gebauer B, Wieners G, De Bucourt M, Renz DM, Hamm B, Streitparth F. Treatment of osteoid osteoma using CT-guided radiofrequency ablation versus MR-guided laser ablation: a cost comparison. Eur J Radiol 2012; 81:e1002-6. [PMID: 22901712 DOI: 10.1016/j.ejrad.2012.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/11/2012] [Accepted: 07/09/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the costs of CT-guided radiofrequency ablation (RFA) and MR-guided laser ablation (LA) for minimally invasive percutaneous treatment of osteoid osteoma. MATERIALS AND METHODS Between November 2005 and October 2011, 20 patients (14 males, 6 females, mean age 20.3±9.1 years) underwent CT-guided RFA and 24 patients (18 males, 6 females; mean age, 23.8±13.8 years) MR-guided LA (open 1.0 Tesla, Panorama HFO, Philips, Best, Netherlands) for osteoid osteoma diagnosed on the basis of clinical presentation and imaging findings. Prorated costs of equipment use (purchase, depreciation, and maintenance), staff costs, and expenditure for disposables were identified for CT-guided RFA and MR-guided LA procedures. RESULTS The average total costs per patient were EUR 1762 for CT-guided RFA and EUR 1417 for MR-guided LA. These were (RFA/LA) EUR 92/260 for equipment use, EUR 149/208 for staff, and EUR 870/300 for disposables. CONCLUSION MR-guided LA is less expensive than CT-guided RFA for minimally invasive percutaneous ablation of osteoid osteoma. The higher costs of RFA are primarily due to the higher price of the disposable RFA probes.
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Affiliation(s)
- M H Maurer
- Charité-Universitätsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin, Germany.
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Streitparth F, Hartwig T, Schnackenburg B, Strube P, Putzier M, De Bucourt M, Hamm B, Teichgräber U. MR gesteuerte Diskographie in der offenen Hochfeld MRT bei 1 Tesla. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Streitparth F, Hartwig T, Schnackenburg B, Strube P, Putzier M, Chopra S, De Bucourt M, Hamm B, Teichgräber U. MR-guided discography using an open 1 Tesla MRI system. Eur Radiol 2010; 21:1043-9. [DOI: 10.1007/s00330-010-2011-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 10/02/2010] [Accepted: 10/14/2010] [Indexed: 10/18/2022]
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