Key result
US-assisted catheter-directed thrombolysis improves RV recovery over anticoagulation alone in intermediate-risk PE.
Why the study?
Does ultrasound-assisted catheter-directed thrombolysis improve right ventricular dysfunction and dilatation in patients with intermediate- and high-risk acute pulmonary embolism compared to anticoagulation alone?
Systematic Review
Does ultrasound-assisted catheter-directed thrombolysis improve right ventricular dysfunction and dilatation in patients with intermediate- and high-risk acute pulmonary embolism compared to anticoagulation alone?
Ultrasound-assisted catheter-directed thrombolysis is an effective contemporary technique for reversing right ventricular dysfunction in intermediate-risk pulmonary embolism, though randomized data for high-risk patients and direct comparisons to systemic therapies are lacking.
Pulmonary embolism remains a common and potentially life-threatening disease. For patients with intermediate- and high-risk pulmonary embolism, catheter-based revascularization therapy has emerged as potential alternative to systemic thrombolysis or surgical embolectomy. Ultrasound-assisted catheter-directed thrombolysis is a contemporary catheter-based technique and is the focus of the present review. Ultrasound-assisted catheter-directed thrombolysis is more effective in reversing right ventricular dysfunction and dilatation in comparison with anticoagulation alone in patients at intermediate risk. However, a direct comparison of ultrasound-assisted thrombolysis with systemic thrombolysis or surgical thrombectomy is not available. Ultrasound-assisted thrombolysis with initial intrapulmonary thrombolytic bolus may also be effective in high-risk patients, but evidence from randomized trials is not available. This review summarizes current data on ultrasound-assisted thrombolysis for acute pulmonary embolism.
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Engelberger et al. (2014) conducted a systematic review in acute pulmonary embolism. Ultrasound-assisted catheter-directed thrombolysis vs. anticoagulation alone was evaluated on reversal of right ventricular dysfunction and dilatation. Ultrasound-assisted catheter-directed thrombolysis is more effective in reversing right ventricular dysfunction and dilatation compared with anticoagulation alone in intermediate-risk patients.
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