Abstract
Acute pulmonary embolism is the third leading cause of cardiovascular mortality and the most preventable cause of hospital mortality. Anticoagulation was and remains the standard of care for treatment of pulmonary embolism (PE) and prevention of thrombus extension or recurrence. Anticoagulation, however, does not dissolve thrombus, but rather prevents formation of more clots while intrinsic thrombolytic pathways are slowly taking over. In higher-risk cases, when ventricular function is acutely compromised, faster clot removal is needed to prevent cardiac decompensation. Administration of systemic thrombolytics can be highly effective in rapidly resolving pulmonary thrombus. However, as it can result in significant bleeding complications, or frequently contraindicated (e.g. recent surgery or trauma), interventional treatments to rapidly remove the clot from the pulmonary arteries have always been attractive. Catheter-directed interventions for acute PE, with or without thrombolytics, have been increasingly used over the past decade and evidence on their effectiveness is mounting.
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References
Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12:464–74.
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020;41(4):543–603.
Kahn SR, Houweling AH, Granton J, Rudski L, Dennie C, Hirsch A. Long-term outcomes after pulmonary embolism: current knowledge and future research. Blood Coagul Fibrinolysis. 2014;25(5):407–15.
Avgerinos ED, Chaer RA. Pulmonary embolism: presentation, natural history and treatment. In: Sidawy AP, Perler BA, editors. Rutherford’s vascular surgery and endovascular therapy. 10th ed. Philadelphia: Elsevier; 2022.
Giri J, Sista AK, Weinberg I, Kearon C, Kumbhani DJ, Desai ND, Piazza G, Gladwin MT, Chatterjee S, Kobayashi T, Kabrhel C, Barnes GD. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation. 2019;140(20):e774–801.
Pruszczyk P, Klok FA, Kucher N, Roik M, Meneveau N, Sharp ASP, Nielsen-Kudsk JE, Obradović S, Barco S, Giannini F, Stefanini G, Tarantini G, Konstantinides S, Dudek D. Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention. 2022;18:e623–38.
Abou Ali AN, Cherfan P, Zaghloul MS, Sridharan N, Lebron BR, Toma C, Chaer RA, Avgerinos ED. Institutional trends over a decade in catheter-directed interventions for pulmonary embolism. J Vasc Surg Venous Lymphat Disord. 2022;10(2):287–92.
Carlon TA, Goldman DT, Marinelli BS, Korff RA, Watchmaker JM, Patel RS, Lipson SD, Bishay VL, Lookstein RA. Contemporary management of acute pulmonary embolism: evolution of catheter-based therapy. Radiographics. 2022;42(6):1861–80.
Avgerinos ED, Saadeddin Z, Abou Ali AN, Fish L, Toma C, Chaer M, et al. A meta-analysis of outcomes of catheter-directed thrombolysis for high- and intermediate-risk pulmonary embolism. J Vasc Surg Venous Lymphat Disord. 2018;6(4):530–40.
Avgerinos ED, Chaer RA. Catheter-directed interventions for acute pulmonary embolism. J Vasc Surg. 2015;61(2):559–65. https://doi.org/10.1016/j.jvs.2014.10.036.
Rivera-Lebron BN, Rali PM, Tapson VF. The PERT concept: a step-by-step approach to managing pulmonary embolism. Chest. 2021;159(1):347–55.
Bulman JC, Weinstein JL. Invited commentary: importance of a multidisciplinary approach to pulmonary embolism in the era of catheter-directed therapies. Radiographics. 2022;42(6):E186–7.
Avgerinos ED, Abou Ali A, Toma C, Wu B, Saadeddin Z, McDaniel B, Al-Khoury G, Chaer RA. Catheter directed thrombolysis versus suction thrombectomy in the management of acute pulmonary embolism. J Vasc Surg Venous Lymphat Disord. 2019;7:623.
Cherfan P, Abou Ali AN, Zaghlul MS, et al. Propofol administration during catheter-directed interventions (CDI) for intermediate risk pulmonary embolism is associated with major adverse events. J Vasc Surg Venous Lymphat Disord. 2021;9:621–6.
Al-Bawardy R, Rosenfield K, Borges J, Young MN, Albaghdadi M, Rosovsky R, Kabrhel C. Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature. Perfusion. 2019;34(1):22–8.
Abou Ali AN, Saadeddin Z, Chaer RA, Avgerinos ED. Catheter directed interventions for pulmonary embolism: current status and future prospects. Expert Rev Med Devices. 2020;17(2):103–10.
Avgerinos ED, Chaer RA. Endovascular treatment of iliofemoral deep venous thrombosis and pulmonary embolism. In: Chaikof EL, editor. Atlas of vascular and endovascular therapy. Philadelphia: Elsevier; 2023.
Bashir R, Foster M, Iskander A, Darki A, Jaber W, Rali PM, Lakhter V, Gandhi R, Klein A, Bhatheja R, Ross C, Natarajan K, Nanjundappa A, Angle JF, Ouriel K, Amoroso NE, Firth BG, Comerota AJ, Piazza G, Rosenfield K, Sista AK. Prospective multicenter trial of pharmacomechanical-catheter-directed thrombolysis with the Bashir endovascular catheter for acute pulmonary embolism. JACC Cardiovasc Interv. 2022;S1936-8798(22):01752–6.
Kucher N, Boekstegers P, Müller OJ, Kupatt C, Beyer-Westendorf J, Heitzer T, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation. 2014;129:479.
Tapson VF, Sterling K, Jones N, Elder M, Tripathy U, Brower J, 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(14):1401–10.
Avgerinos ED, Jaber W, Lacomis J, Markel K, McDaniel M, Rivera-Lebron BN, Ross CB, Sechrist J, Toma C, Chaer R, SUNSET sPE Collaborators. Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE trial. JACC Cardiovasc Interv. 2021;14(12):1364–73.
Evaluating the safety and efficacy of the AlphaVac Multipurpose Mechanical Aspiration (MMA) F1885 PE for treatment of acute pulmonary embolism (APEX-AV). Clinicaltrials.gov. Accessed 21 Oct 2022.
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. https://doi.org/10.1016/j.jcin.2020.09.053.
Tu T, Toma C, Tapson VF, Adams C, Jaber WA, Silver M, 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(9):859–69.
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Avgerinos, E., Bouris, V., Chaer, R. (2024). Endovascular Treatment of Pulmonary Embolism. In: Geroulakos, G., Avgerinos, E., Becquemin, J.P., Makris, G.C., Froio, A. (eds) Mastering Endovascular Techniques. Springer, Cham. https://doi.org/10.1007/978-3-031-42735-0_78
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