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Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism

Engelberger, Rolf P. ; Moschovitis, Aris ; Fahrni, Jennifer ; Willenberg, Torsten ; Baumann, Frederic ; Diehm, Nicolas ; Do, Do-Dai ; Baumgartner, Iris ; Kucher, Nils

In: European Heart Journal, 2015, vol. 36, no. 10, p. 597-604

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    Titre
    • Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism
    Auteur
    • Engelberger, Rolf P.. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Moschovitis, Aris. Clinic for Cardiology, Swiss Cardiovascular Center, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Fahrni, Jennifer. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Willenberg, Torsten. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Baumann, Frederic. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Diehm, Nicolas. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Do, Do-Dai. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Baumgartner, Iris. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    • Kucher, Nils. Clinic for Angiology, Inselspital—University Hospital and University of Bern, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Heart Journal, 2015, vol. 36, no. 10, p. 597-604. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:302009
    Summary
    Aims No standardized local thrombolysis regimen exists for the treatment of pulmonary embolism (PE). We retrospectively investigated efficacy and safety of fixed low-dose ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk PE. Methods and results Fifty-two patients (65 ± 14 years) of whom 14 had high-risk PE (troponin positive in all) and 38 intermediate-risk PE (troponin positive in 91%) were treated with intravenous unfractionated heparin and USAT using 10 mg of recombinant tissue plasminogen activator per device over the course of 15 h. Bilateral USAT was performed in 83% of patients. During 3-month follow-up, two [3.8%; 95% confidence interval (CI) 0.5-13%] patients died (one from cardiogenic shock and one from recurrent PE). Major non-fatal bleeding occurred in two (3.8%; 95% CI, 0.5-13%) patients: one intrathoracic bleeding after cardiopulmonary resuscitation requiring transfusion, one intrapulmonary bleeding requiring lobectomy. Mean pulmonary artery pressure decreased from 37 ± 9 mmHg at baseline to 25 ± 8 mmHg at 15 h (P < 0.001) and cardiac index increased from 2.0 ± 0.7 to 2.7 ± 0.9 L/min/m2 (P < 0.001). Echocardiographic right-to-left ventricular end-diastolic dimension ratio decreased from 1.42 ± 0.21 at baseline to 1.06 ± 0.23 at 24 h (n = 21; P < 0.001). The greatest haemodynamic benefit from USAT was found in patients with high-risk PE and in those with symptom duration < 14 days. Conclusion A standardized catheter intervention approach using fixed low-dose USAT for the treatment of intermediate- and high-risk PE was associated with rapid improvement in haemodynamic parameters and low rates of bleeding complications and mortality