Key result
Ultrasound-accelerated catheter-directed thrombolysis significantly reduced the median RV/LV diameter ratio from 0.9 at baseline to 0.7 at 6 months in patients with pulmonary embolism (P=0.001).
Why the study?
Does low-dose ultrasound-accelerated catheter-directed thrombolysis improve right ventricular function and reduce pulmonary artery pressure in patients with massive or submassive pulmonary embolism?
Cohort (n=38)
No
Does low-dose ultrasound-accelerated catheter-directed thrombolysis improve right ventricular function and reduce pulmonary artery pressure in patients with massive or submassive pulmonary embolism?
p-value: p=0.001
Low-dose ultrasound-accelerated catheter-directed thrombolysis significantly improves right ventricular function and pulmonary artery pressure in patients with massive or submassive pulmonary embolism.
May improve RV function and PAP in PE; hypothesis-generating, requires RCTs before practice change.
BACKGROUND: This study aims to evaluate the efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the treatment of massive and submassive pulmonary embolism (PE). METHODS: We conducted a prospective, observational cohort study of consequtive patients with massive or submassive PE treated with low-dose UACDT using EKOS EkoSonic® system at single center from May 2014 until April 2015. Overall, thirty-eight patients (median age, 64.5 years) were included. The primary safety outcomes were change in right ventricular (RV) to left ventricular (LV) diameter ratio within 24 hours of procedure initiation, at 1- and 6-month follow-up and major bleeding within 96 hours of the procedure initiation. BNP, troponin and D-dimer levels were also measured. RESULTS: The ultrasound-accelerated thrombolytic catheters were bilaterally placed in 25 (65.8%) patients. The median tissue plasminogen activator (tPA) dose for all patients in our study was 21.0 mg and the median infusion time was 15 hours. Measurements before and after treatment showed a decrease in pulmonary artery pressure. The median value of RV/LV diameter ratio decreased from 0.9 (0.7-1.1) at baseline to 0.7 (0-0.97) at 6-month follow-up (P=0.001) and pulmonary artery pressure from 61.4 ±16.7 to 37.2±9.1 mmHg (P=0.001). The median BNP level at baseline was 169 (29-721) pg/mL and 45.5 (0-328) pg/mL at 6 month follow-up (P=0.001). Of 38 patients with PE, one had intracranial hemorrage, one gastrointestinal bleeding and two developed puncture site bleeding. CONCLUSIONS: This prospective study provides alternative treatment option and an addition to the treatment algorithm for the management of pulmonary embolism.
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Özçınar et al. (2017) conducted a cohort in Massive and submassive pulmonary embolism (n=38). Ultrasound-accelerated catheter-directed thrombolysis (UACDT) was evaluated on Change in right ventricular (RV) to left ventricular (LV) diameter ratio within 24 hours of procedure initiation, at 1- and 6-month follow-up and major bleeding within 96 hours (p=0.001). Ultrasound-accelerated catheter-directed thrombolysis significantly reduced the median RV/LV diameter ratio from 0.9 at baseline to 0.7 at 6 months in patients with pulmonary embolism (P=0.001).
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