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open access

Vol 30, No 3 (2023)
Review Article
Submitted: 2022-04-14
Accepted: 2022-07-24
Published online: 2022-08-11
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Catheter-directed therapy to treat intermediateand high-risk pulmonary embolism: Personal experience and review of the literature

Arkadiusz Pietrasik1, Aleksandra Gasecka1, Aleksander Kotulecki1, Paulina Karolak1, Aleksander Araszkiewicz2, Szymon Darocha3, Marcin Grabowski1, Marcin Kurzyna3
DOI: 10.5603/CJ.a2022.0075
·
Pubmed: 35975795
·
Cardiol J 2023;30(3):462-472.
Affiliations
  1. 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland
  2. 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
  3. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center Otwock, Poland

open access

Vol 30, No 3 (2023)
Review articles — Interventional cardiology
Submitted: 2022-04-14
Accepted: 2022-07-24
Published online: 2022-08-11

Abstract

Pulmonary embolism (PE) is the third leading cause of cardiovascular death in the western world.
Prompt recognition, risk stratification, and individualized treatment are crucial to improve outcomes in
patients with PE. Anticoagulation alone is a sufficient therapeutic option in low-risk patients, whereas
primary reperfusion with systemic thrombolysis (ST) is usually chosen in high-risk patients. The
choice of treatment in intermediate-risk patients is complex and depends on the clinical presentation.
Catheter-directed therapy (CDTh) includes all therapies delivered via a catheter placed in the branches
of the pulmonary arteries directly into the thrombus. Because ST bears a high risk of major bleeding and
numerous patients have contraindications to ST, CDTh is an alternative to ST in intermediate- and
high-risk PE patients. CDTh includes local thrombolysis using low-dose alteplase, ultrasound-assisted
thrombolysis, and mechanical fragmentation and aspiration of the thrombi, as well as their combinations.
In this review article, we have summarized devices and technical details for CDTh, discussed the
efficacy and safety of CDTh in comparison to ST in previous clinical trials, and outlined future research
directions regarding CDTh, both based on the literature and our personal experience from the local PE
Response Team of the Center for the Management of Pulmonary Embolism (CELZAT) in Warsaw

Abstract

Pulmonary embolism (PE) is the third leading cause of cardiovascular death in the western world.
Prompt recognition, risk stratification, and individualized treatment are crucial to improve outcomes in
patients with PE. Anticoagulation alone is a sufficient therapeutic option in low-risk patients, whereas
primary reperfusion with systemic thrombolysis (ST) is usually chosen in high-risk patients. The
choice of treatment in intermediate-risk patients is complex and depends on the clinical presentation.
Catheter-directed therapy (CDTh) includes all therapies delivered via a catheter placed in the branches
of the pulmonary arteries directly into the thrombus. Because ST bears a high risk of major bleeding and
numerous patients have contraindications to ST, CDTh is an alternative to ST in intermediate- and
high-risk PE patients. CDTh includes local thrombolysis using low-dose alteplase, ultrasound-assisted
thrombolysis, and mechanical fragmentation and aspiration of the thrombi, as well as their combinations.
In this review article, we have summarized devices and technical details for CDTh, discussed the
efficacy and safety of CDTh in comparison to ST in previous clinical trials, and outlined future research
directions regarding CDTh, both based on the literature and our personal experience from the local PE
Response Team of the Center for the Management of Pulmonary Embolism (CELZAT) in Warsaw

Full Text:

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Keywords

pulmonary embolism, catheter-based therapy, interventional cardiology, review

About this article
Title

Catheter-directed therapy to treat intermediateand high-risk pulmonary embolism: Personal experience and review of the literature

Journal

Cardiology Journal

Issue

Vol 30, No 3 (2023)

Article type

Review Article

Pages

462-472

Published online

2022-08-11

Page views

2463

Article views/downloads

617

DOI

10.5603/CJ.a2022.0075

Pubmed

35975795

Bibliographic record

Cardiol J 2023;30(3):462-472.

Keywords

pulmonary embolism
catheter-based therapy
interventional cardiology
review

Authors

Arkadiusz Pietrasik
Aleksandra Gasecka
Aleksander Kotulecki
Paulina Karolak
Aleksander Araszkiewicz
Szymon Darocha
Marcin Grabowski
Marcin Kurzyna

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