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Endovascular Management of Massive and Submassive Acute Pulmonary Embolism: Current Trends in Risk Stratification and Catheter-Directed Therapies

  • Peripheral Vascular Disease (CJ Cooper and R Gupta, Section Editors)
  • Published:
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Abstract

Purpose of Review

Acute pulmonary embolism (PE) is a common condition associated with high morbidity and mortality. Prior studies have evaluated the role of systemic fibrinolysis and catheter-directed therapy (CDT) in the management of PE. In this review, we examine current data on risk stratification and the appropriate allocation of systemic fibrinolysis and CDT in acute PE patients with elevated risk of adverse outcomes.

Recent Findings

Classification of pulmonary embolism is based on risk of adverse events, and relies on clinical parameters, imaging findings, and biomarkers. The synthesis of this data permits appropriate risk stratification of acute PE patients, and is the foundation upon which treatment decisions are made. While systemic thrombolytics remain the frontline therapy for hemodynamically unstable PE patients, studies have suggested that CDT has a significant promise as the primary modality for treating hemodynamically stable patients at increased risk for clinical decompensation and as an alternative therapy for hemodynamically unstable patients who may not tolerate systemic thrombolytics.

Summary

The appropriate use of CDT in patients with acute PE is dependent on accurate risk stratification. CDT offers the potential to reduce excessive bleeding while maintaining the efficacy of systemic thrombolytics, but will require data from larger randomized trials to support its use prior to widespread adoption as the frontline therapy for PE in patients at elevated risk of adverse outcomes.

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Authors and Affiliations

  1. Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, IL, 60611, USA

    Ethan C. Kosova & Daniel R. Schimmel

  2. Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Kush R. Desai

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  1. Ethan C. Kosova
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Correspondence to Daniel R. Schimmel.

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Ethan C. Kosova and Daniel R. Schimmel declare that they have no conflict of interest.

Kush R. Desai reports personal fees from Cook Medical.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Peripheral Vascular Disease

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Kosova, E.C., Desai, K.R. & Schimmel, D.R. Endovascular Management of Massive and Submassive Acute Pulmonary Embolism: Current Trends in Risk Stratification and Catheter-Directed Therapies. Curr Cardiol Rep 19, 54 (2017). https://doi.org/10.1007/s11886-017-0864-8

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  • DOI: https://doi.org/10.1007/s11886-017-0864-8

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