Catheter-directed ultrasound-accelerated thrombolysis for the treatment of acute pulmonary embolism |
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Authors: | Engelhardt Tod C Taylor Allen J Simprini Lauren A Kucher Nils |
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Affiliation: | a Thoracic Surgery, Louisiana Heart, Lung and Vascular Institute, Metairie, LA USAb Department of Medicine, Cardiovascular Research Institute, Washington Hospital Center, Washington DC USAc Venous Thromboembolism Research Group, Swiss Cardiovascular Center, University Hospital Bern, Switzerland |
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Abstract: | BackgroundSystemic thrombolysis rapidly improves right ventricular (RV) dysfunction in patients with acute pulmonary embolism (PE) but is associated with major bleeding complications in up to 20%. The efficacy of low-dose, catheter-directed ultrasound-accelerated thrombolysis (USAT) on the reversal of RV dysfunction is unknown.Materials and methodsWe performed a retrospective analysis of 24 PE patients (60 ± 16 years) at intermediate (n = 19) or high risk (n = 5) from the East Jefferson General Hospital who were treated with USAT (mean rt-PA dose 33.5 ± 15.5 mg over 19.7 hours) and received multiplanar contrast-enhanced chest computed tomography (CT) scans at baseline and after USAT at 38 ± 14 hours. All CT measurements were performed by an independent core laboratory.ResultsThe right-to-left ventricular dimension ratio (RV/LV ratio) from reconstructed CT four-chamber views at baseline of 1.33 ± 0.24 was significantly reduced to 1.00 ± 0.13 at follow-up by repeated-measures analysis of variance (p < 0.001). The CT-angiographic pulmonary clot burden as assessed by the modified Miller score was significantly reduced from 17.8 ± 5.3 to 8.7 ± 5.1 (p < 0.001). All patients were discharged alive, and there were no systemic bleeding complications but four major access site bleeding complications requiring transfusion and one suspected recurrent massive PE event.ConclusionsIn patients with intermediate and high risk PE, low-dose USAT rapidly reverses right ventricular dilatation and pulmonary clot burden. |
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Keywords: | RV, right ventricular PE, pulmonary embolism USAT, ultrasound accelerated thrombolysis CDT, catheter-directed thrombolysis rt-PA, recombinant tissue plasminogen activator CT, computed tomography RV/LV ratio, right-to-left ventricular dimension ratio LOS, length-of-stay IDDC, intelligent drug delivery catheter MSD, microSonic device |
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