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Catheter-directed therapy in pulmonary embolism

Kathetergestützte Interventionen bei Lungenembolie

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Abstract

Acute pulmonary embolism (PE) is a life-threatening condition with high mortality rates and potential long-term sequelae. Systemic thrombolysis has been virtually the only therapeutic option available for patients with hemodynamic instability over decades. Recently, interventional therapy of PE has gained increasing interest. Multiple devices were developed; these include devices for local thrombolysis, thrombus fragmentation, thrombus aspiration, and combined approaches. However, the available evidence is limited to mostly small, nonrandomized studies. In these studies, safety and efficacy data from patients with intermediate or high-risk PE are promising. However, due to the lack of adequately powered randomized trials, interventional treatment of intermediate or high-risk PE cannot be recommended as standard-of-care. The decision on whether and how to perform a catheter-based intervention should therefore be left to the discretion of the local team, depending on the patients’ clinical status, bleeding risk, local expertise, and available devices. The implementation of local multidisciplinary PE response teams is recommended by international guidelines to provide the best possible treatment.

Zusammenfassung

Die akute Lungenembolie ist eine lebensbedrohliche Erkrankung mit hoher Mortalität und möglichen Langzeitfolgen. Über Jahrzehnte war die systemische Thrombolyse die einzige therapeutische Option bei Patienten mit hämodynamischer Instabilität. Die interventionelle Therapie der Lungenembolie gewinnt zunehmend an Bedeutung. Aktuell zugelassene katheterbasierte Verfahren umfassen die lokale Thrombolyse, Thrombusfragmentierung, Thrombusaspiration und kombinierte Methoden. Die verfügbare Evidenz beschränkt sich meist auf kleine, nichtrandomisierte Studien. In diesen Studien sind die Sicherheits- und Wirksamkeitsdaten bei Patienten mit intermediärer oder Hochrisikolungenembolie vielversprechend. Aufgrund des Mangels an aussagekräftigen randomisierten Studien kann die interventionelle Behandlung der Lungenembolie bei Patienten mit erhöhtem oder hohem Risiko jedoch nicht als Standardbehandlung empfohlen werden. Die Entscheidung, ob und wie eine kathetergestützte Intervention durchgeführt wird, sollte daher dem Ermessen des lokalen Teams überlassen werden, abhängig vom klinischen Status des Patienten, dem Blutungsrisiko, der lokalen Expertise und den verfügbaren Geräten. Die Implementierung lokaler multidisziplinärer Lungenembolie-Teams wird von internationalen Leitlinien empfohlen, um die bestmögliche Behandlung zu gewährleisten.

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Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany

    Dmitry S. Sulimov MD, Anne Freund MD & Holger Thiele MD

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  1. Dmitry S. Sulimov MD
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  2. Anne Freund MD
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  3. Holger Thiele MD
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Correspondence to Dmitry S. Sulimov MD.

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Conflict of interest

D. S. Sulimov, A. Freund and H. Thiele declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

D. S. Sulimov and A. Freund contributed equally to this article.

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Sulimov, D.S., Freund, A. & Thiele, H. Catheter-directed therapy in pulmonary embolism. Herz 46, 399–405 (2021). https://doi.org/10.1007/s00059-021-05059-6

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