Journal of Thrombosis and Thrombolysis

, Volume 42, Issue 3, pp 322–328 | Cite as

Catheter-directed ultrasound-accelerated thrombolysis may be life-saving in patients with massive pulmonary embolism after failed systemic thrombolysis

  • Saim Sag
  • Omer Fatih Nas
  • Aysel Aydin Kaderli
  • Bulent Ozdemir
  • İbrahim Baran
  • Cuneyt Erdoğan
  • Sumeyye Gullulu
  • Bahattin Hakyemez
  • Ali Aydinlar
Article

Abstract

The treatment options for high risk acute pulmonary embolism (PE) patients with failed systemic thrombolytic treatment (STT) is limited. The clinical use of catheter directed thrombolysis with the EkoSonic Endovascular System (EKOS) in this population has not been evaluated before. Catheter directed thrombolysis is an effective treatment modality for high risk PE patients with failed STT. Thirteen consecutive patients with failed STT were included in the study. EKOS catheters were placed and tissue plasminogen activator (t-PA) in combination with unfractionated heparin were given. Clinical and echocardiographic properties of the patients were collected before EKOS, at the end of EKOS and during the follow-up visit 6 months after discharge. The duration of EKOS treatment was 21.8 ± 3.8 h and the total dose of tPA was 31.2 ± 15.3 mg. One patient who presented with cardiac arrest died and the clinical status of the remaining subjects improved significantly. Any hemorrhagic complication was not observed. EKOS resulted in significant improvement of right ventricular functions and decrease of systolic pulmonary artery pressure. During a follow-up period of 6 months none of the patients died or suffered recurrent PE. In addition, echocardiographic parameters or right ventricular function significantly got better compared to in-hospital measurements. EKOS is an effective treatment modality for high risk PE patients with failed STT and can be applied with very low hemorrhagic complications.

Keywords

Acute pulmonary embolism Failed systemic thrombolytic treatment Catheter directed thrombolysis EkoSonic Endovascular System 

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Saim Sag
    • 1
  • Omer Fatih Nas
    • 2
  • Aysel Aydin Kaderli
    • 1
  • Bulent Ozdemir
    • 1
  • İbrahim Baran
    • 1
  • Cuneyt Erdoğan
    • 2
  • Sumeyye Gullulu
    • 1
  • Bahattin Hakyemez
    • 2
  • Ali Aydinlar
    • 1
  1. 1.Department of CardiologyUludag University Medical SchoolBursaTurkey
  2. 2.Department of RadiologyUludag University School of MedicineBursaTurkey

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