open access

Vol 27, No 4 (2020)
Original articles — Clinical cardiology
Published online: 2020-04-17
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Catheter directed thrombolytic therapy and aspiration thrombectomy in intermediate pulmonary embolism with long term results

Zoltan Ruzsa, Zoltan Vámosi, Balázs Berta, Balázs Nemes, Károly Tóth, Nándor Kovács, Endre Zima, Dávid Becker, Béla Merkely
DOI: 10.5603/CJ.a2020.0060
·
Pubmed: 32329040
·
Cardiol J 2020;27(4):368-375.

open access

Vol 27, No 4 (2020)
Original articles — Clinical cardiology
Published online: 2020-04-17

Abstract

Background: Catheter directed thrombolysis (CDT) and thrombectomy represent well established techniques for the treatment of intermediate pulmonary embolism (IPE). The long-term effect of catheter
directed thrombolysis of IPE is unknown.
Methods: Clinical, interventional and echocardiographic data from 80 consecutive patients with IPE who were treated with CDT were evaluated. Primary end-points were technical success and major adverse events. Secondary end-points were cardiovascular mortality, all-cause mortality, clinical success, rate of bleeding complications, improvement in pulmonary pressure and echocardiography parameters. CDT completed with alteplase (10 mg bolus and 1 mg/h maintenance dose) through a pig-tail catheter for 24 h. After 24 h, control pulmonary angiography was performed.
Results: In total, 80 patients with a mean age of 59.0 ± 16.8 years were treated. CDT was successful after the first post-operative day in 72 (90%) patients, but thrombus aspiration and fragmentation was performed due to failed thrombolysis in 8 (10%) patients. Final technical and clinical success was reached in 79 (98.8%) and 77 (96.3%) patients, respectively. The mean CDT time in IPE was 27.8 ± 9.6 h. Invasive pulmonary pressure dropped from 57.5 ± 16.7 to 38.9 ± 13.5 (p < 0.001). A caval filter was implanted in 4 (5%) patients. The 1-year major adverse events and cardiovascular mortality rate was 4.0% and 1.4%, respectively. Access site complications (6 major and 6 minor) were encountered in 12 (16.2%) patients.
Conclusions: Catheter directed thrombolysis in submassive pulmonary embolism had excellent results. However, additional mechanical thrombectomy was necessary in some patients to achieve good clinical outcomes.

Abstract

Background: Catheter directed thrombolysis (CDT) and thrombectomy represent well established techniques for the treatment of intermediate pulmonary embolism (IPE). The long-term effect of catheter
directed thrombolysis of IPE is unknown.
Methods: Clinical, interventional and echocardiographic data from 80 consecutive patients with IPE who were treated with CDT were evaluated. Primary end-points were technical success and major adverse events. Secondary end-points were cardiovascular mortality, all-cause mortality, clinical success, rate of bleeding complications, improvement in pulmonary pressure and echocardiography parameters. CDT completed with alteplase (10 mg bolus and 1 mg/h maintenance dose) through a pig-tail catheter for 24 h. After 24 h, control pulmonary angiography was performed.
Results: In total, 80 patients with a mean age of 59.0 ± 16.8 years were treated. CDT was successful after the first post-operative day in 72 (90%) patients, but thrombus aspiration and fragmentation was performed due to failed thrombolysis in 8 (10%) patients. Final technical and clinical success was reached in 79 (98.8%) and 77 (96.3%) patients, respectively. The mean CDT time in IPE was 27.8 ± 9.6 h. Invasive pulmonary pressure dropped from 57.5 ± 16.7 to 38.9 ± 13.5 (p < 0.001). A caval filter was implanted in 4 (5%) patients. The 1-year major adverse events and cardiovascular mortality rate was 4.0% and 1.4%, respectively. Access site complications (6 major and 6 minor) were encountered in 12 (16.2%) patients.
Conclusions: Catheter directed thrombolysis in submassive pulmonary embolism had excellent results. However, additional mechanical thrombectomy was necessary in some patients to achieve good clinical outcomes.

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Keywords

pulmonary embolism, local thrombolysis

About this article
Title

Catheter directed thrombolytic therapy and aspiration thrombectomy in intermediate pulmonary embolism with long term results

Journal

Cardiology Journal

Issue

Vol 27, No 4 (2020)

Pages

368-375

Published online

2020-04-17

DOI

10.5603/CJ.a2020.0060

Pubmed

32329040

Bibliographic record

Cardiol J 2020;27(4):368-375.

Keywords

pulmonary embolism
local thrombolysis

Authors

Zoltan Ruzsa
Zoltan Vámosi
Balázs Berta
Balázs Nemes
Károly Tóth
Nándor Kovács
Endre Zima
Dávid Becker
Béla Merkely

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