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Evidence-Based Update on Transcatheter Therapies for Pulmonary Embolism

  • Structural Heart Disease (S Vakamudi, Section Editor)
  • Published:
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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.

Summary

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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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163:1711–7.

    Article  PubMed  Google Scholar 

  2. Alotaibi GS, Wu C, Senthilselvan A, McMurtry MS. Secular trends in incidence and mortality of acute venous thromboembolism: the AB-VTE population-based study. Am J Med. 2016;129(879):e19-25.

    Google Scholar 

  3. Fernandez MM, Hogue S, Preblick R, Kwong WJ. Review of the cost of venous thromboembolism. ClinicoEconomics and outcomes research : CEOR. 2015;7:451–62.

    Article  PubMed  Google Scholar 

  4. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4:4693–738.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. • Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54. The ESC guidelines present a commonly used algorithm for risk stratification of patients with PE. This contemporary stratification system is frequently implemented in current practice and decision making in the care of PE patients.

  6. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315–52.

    Article  PubMed  Google Scholar 

  7. Frémont B, Pacouret G, Jacobi D, Puglisi R, Charbonnier B, de Labriolle A. Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients. Chest. 2008;133:358–62.

    Article  PubMed  Google Scholar 

  8. van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005;235:798–803.

    Article  PubMed  Google Scholar 

  9. Grifoni S, Vanni S, Magazzini S, et al. Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events. Arch Intern Med. 2006;166:2151–6.

    Article  PubMed  Google Scholar 

  10. Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113:577–82.

    Article  PubMed  Google Scholar 

  11. • Natanzon SS, Fardman A, Chernomordik F, et al. PESI score for predicting clinical outcomes in PE patients with right ventricular involvement. Heart and vessels. 2022;37:489–95. This work presents the PESI risk score for risk stratifying patients with pulmonary embolism to guide decision making in therapy.

    Article  PubMed  Google Scholar 

  12. Collen D, Lijnen RH. Thrombolytic agents. Thromb Haemost. 2005;93:627–30.

    Article  CAS  PubMed  Google Scholar 

  13. Urokinase pulmonary embolism trial. Phase 1 results: a cooperative study. JAMA. 1970;214:2163–72.

    Google Scholar 

  14. Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370:1402–11.

    Article  CAS  PubMed  Google Scholar 

  15. Konstantinides SV, Vicaut E, Danays T, et al. Impact of thrombolytic therapy on the long-term outcome of intermediate-risk pulmonary embolism. J Am Coll Cardiol. 2017;69:1536–44.

    Article  CAS  PubMed  Google Scholar 

  16. Marti C, John G, Konstantinides S, et al. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J. 2015;36:605–14.

    Article  CAS  PubMed  Google Scholar 

  17. Schmitz-Rode T, Janssens U, Duda SH, Erley CM, Günther RW. Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter. J Am Coll Cardiol. 2000;36:375–80.

    Article  CAS  PubMed  Google Scholar 

  18. Bonvini RF, Righini M, Roffi M. Angiojet rheolytic thrombectomy in massive pulmonary embolism: locally efficacious but systemically deleterious? J Vasc Interv Radiol. 2010;21:1774–6; author reply 6-7.

    Article  PubMed  Google Scholar 

  19. Tapson VF, Gurbel PA, Witty LA, Pieper KS, Stack RS. Pharmacomechanical thrombolysis of experimental pulmonary emboli. Rapid low-dose intraembolic therapy Chest. 1994;106:1558–62.

    CAS  PubMed  Google Scholar 

  20. Blinc A, Francis CW, Trudnowski JL, Carstensen EL. Characterization of ultrasound-potentiated fibrinolysis in vitro. Blood. 1993;81:2636–43.

    Article  CAS  PubMed  Google Scholar 

  21. Francis CW, Blinc A, Lee S, Cox C. Ultrasound accelerates transport of recombinant tissue plasminogen activator into clots. Ultrasound Med Biol. 1995;21:419–24.

    Article  CAS  PubMed  Google Scholar 

  22. Owens CA. Ultrasound-enhanced thrombolysis: EKOS EndoWave infusion catheter system. Semin Interv Radiol. 2008;25:37–41.

    Article  Google Scholar 

  23. Kucher N, Boekstegers P, Müller OJ, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation. 2014;129:479–86.

    Article  PubMed  Google Scholar 

  24. Piazza G, Hohlfelder B, Jaff MR, et al. A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. JACC Cardiovasc Interv. 2015;8:1382–92.

    Article  PubMed  Google Scholar 

  25. Tapson VF, Sterling K, Jones N, et al. A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial. JACC Cardiovasc Interv. 2018;11:1401–10.

    Article  PubMed  Google Scholar 

  26. An international pulmonary embolism registry using EKOS - full text view. 2018, February 8. https://classic.clinicaltrials.gov/ct2/show/NCT03426124.

  27. Sterling K. KNOCOUT PE: retrospective and prospective international EKoSoNic registry of the treatment and clinical outcomes of patients with pulmonary embolism. Vascular InterVentional Advances Conference; 2021; Las Vegas, NV.

  28. Avgerinos ED, Jaber W, Lacomis J, et al. Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE trial. JACC Cardiovasc Interv. 2021;14:1364–73.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Klok FA, Piazza G, Sharp ASP, Ní Ainle F, Jaff MR, Chauhan N, et al. Ultrasound-facilitated,catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: Rationale and design of the HI-PEITHO study. Am Heart J. 2022;251:43–53. https://doi.org/10.1016/j.ahj.2022.05.011. Epub 2022 May 16. PMID: 35588898.

  30. Sista AK, Bhatheja R, Rali P, et al. First-in-human study to assess the safety and feasibility of the bashir endovascular catheter for the treatment of acute intermediate-risk pulmonary embolism. Circ Cardiovasc Interv. 2021;14: e009611.

    Article  CAS  PubMed  Google Scholar 

  31. Bashir R, Foster M, Iskander A, et al. Pharmacomechanical catheter-directed thrombolysis with the bashir endovascular catheter for acute pulmonary embolism: the RESCUE study. JACC Cardiovasc Interv. 2022;15:2427–36.

    Article  PubMed  Google Scholar 

  32. Tu T, Toma C, Tapson VF, et al. A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study. JACC Cardiovasc Interv. 2019;12:859–69.

    Article  PubMed  Google Scholar 

  33. Toma C, Bunte MC, Cho KH, et al. Percutaneous mechanical thrombectomy in a real-world pulmonary embolism population: interim results of the FLASH registry. Catheter Cardiovasc Interv: J Soc Cardiovasc Angiogr Interv. 2022;99:1345–55.

    Article  Google Scholar 

  34. Silver MJ, Gibson CM, Giri J, Khandhar S, Jaber W, Toma C, et al. Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy or Other Contemporary Therapies: Results From the FLAME Study. Circ Cardiovasc Interv. 2023:16(10):e013406. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013406. Epub 2023. PMID: 37847768; PMCID: PMC10573120.

  35. Saxon RR, Benenati JF, Teigen C, Adams GL, Sewall LE. Utility of a power aspiration-based extraction technique as an initial and secondary approach in the treatment of peripheral arterial thromboembolism: results of the multicenter PRISM trial. J Vasc Interv Radiol. 2018;29:92–100.

    Article  PubMed  Google Scholar 

  36. Sista AK, Horowitz JM, Tapson VF, et al. Indigo aspiration system for treatment of pulmonary embolism: results of the EXTRACT-PE trial. JACC Cardiovasc Interv. 2021;14:319–29.

    Article  PubMed  Google Scholar 

  37. Robertson B, Neville E, Muck A, et al. Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device. J Vasc Surg Venous Lymphat Disord. 2022;10:594–601.

    Article  PubMed  Google Scholar 

  38. Enezate T, Alkhatib D, Raja J, Chinta V, Patel M, Omran J. AngioVac for minimally invasive removal of intravascular and intracardiac masses: a systematic review. Curr Cardiol Rep. 2022;24:377–82.

    Article  PubMed  Google Scholar 

  39. Evaluating the Safety and Efficacy of the AlphaVac Multipurpose Mechanical Aspiration (MMA) F1885 PE for Treatment of Acute Pulmonary Embolism (APEX-AV); Clinicaltrials.gov. 2022. https://clinicaltrials.gov/study/NCT05318092.

  40. Ain DL, Albaghdadi M, Giri J, et al. Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: two eras at an urban tertiary care hospital. Vascular medicine (London, England). 2018;23:60–4.

    Article  PubMed  Google Scholar 

  41. Karami M, Mandigers L, Miranda DDR, et al. Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: a systematic review and meta-analysis. J Crit Care. 2021;64:245–54.

    Article  CAS  PubMed  Google Scholar 

  42. Zuin M, Rigatelli G, Daggubati R, Nguyen T, Roncon L. Impella RP in hemodynamically unstable patients with acute pulmonary embolism. J Artif Organs: J Japanese Soc Artif Organs. 2020;23:105–12.

    Article  CAS  Google Scholar 

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Correspondence to Peter Monteleone.

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Conflict of Interest

Dr. Paul holds grants from Inari Medical, receives consulting fees from Boston Scientific and AIDOC, and participates in the data safety and monitoring board for the APEX-AV trial. He also holds equity in Flow Medical, and he has a patent (International Publication Number WO 2023/288268 A1). Dr. Monteleone receives consulting fees from Abbott, Boston Scientific, Medtronic, Heartflow, and Penumbra; received payment or honoraria from Boston Scientific and Medtronic; and serves on the scientific advisory board for Boston Scientific, Medtronic, and Heartflow. Dr. Patel has nothing to disclose.

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Monteleone, P., Patel, A. & Paul, J. Evidence-Based Update on Transcatheter Therapies for Pulmonary Embolism. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02060-3

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