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Haner Wasserstein D, Frishman WH. FlowTriever System for Pulmonary Embolism: A Review of Clinical Evidence. Cardiol Rev 2023:00045415-990000000-00166. [PMID: 37909737 DOI: 10.1097/crd.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, and its incidence has been increasing due to the growing aging population. Systemic or catheter-directed thrombolytic treatment for PE has an increased risk of bleeding that may offset the benefit in some patients. Mechanical thrombectomy devices such as the FlowTriever System are designed to resolve vascular occlusion and correct ventilation-perfusion mismatch without the need for thrombolytic drugs. This review covers the FlowTriever system, clinical data from the FlowTriever Pulmonary Embolectomy Clinical Study, FlowTriever for Acute Massive Pulmonary Embolism, and FlowTriever All-comer Registry for Patient Safety and Hemodynamics trials, and real-world experiences, demonstrating its safety and effectiveness in treating intermediate-risk and high-risk PE. Additionally, we explore off-label uses of the FlowTriever System for various large vessel thromboses.
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Affiliation(s)
| | - William H Frishman
- Department of Internal Medicine, New York Medical College at Westchester Medical Center, Valhalla, NY
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2
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Mata Salvador MC, Osorio J, Zarco F, Moises J. [Catheter-Directed Thrombectomy in High-Risk Pulmonary Thromboembolism: A Case Report]. OPEN RESPIRATORY ARCHIVES 2023; 5:100269. [PMID: 37818451 PMCID: PMC10560829 DOI: 10.1016/j.opresp.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Affiliation(s)
| | - Jeisson Osorio
- Servicio de Neumología, Hospital Clínic de Barcelona, Barcelona, España
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic De Barcelona, Barcelona, España
| | - Federico Zarco
- Centro de diagnóstico para la Imagen, Hospital Clínic de Barcelona, Barcelona,España
| | - Jorge Moises
- Servicio de Neumología, Hospital Clínic de Barcelona, Barcelona, España
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic De Barcelona, Barcelona, España
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3
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Carroll BJ, Larnard EA, Pinto DS, Giri J, Secemsky EA. Percutaneous Management of High-Risk Pulmonary Embolism. Circ Cardiovasc Interv 2023; 16:e012166. [PMID: 36744463 DOI: 10.1161/circinterventions.122.012166] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pulmonary embolism (PE) leads to an abrupt increase in pulmonary vascular resistance and right ventricular afterload, and when significant enough, can result in hemodynamic instability. High-risk PE is a dire cardiovascular emergency and portends a poor prognosis. Traditional therapeutic options to rapidly reduce thrombus burden like systemic thrombolysis and surgical pulmonary endarterectomy have limitations, both with regards to appropriate candidates and efficacy, and have limited data demonstrating their benefit in high-risk PE. There are growing percutaneous treatment options for acute PE that include both localized thrombolysis and mechanical embolectomy. Data for such therapies with high-risk PE are currently limited. However, given the limitations, there is an opportunity to improve outcomes, with percutaneous treatments options offering new mechanisms for clot reduction with a possible improved safety profile compared with systemic thrombolysis. Additionally, mechanical circulatory support options allow for complementary treatment for patients with persistent instability, allowing for a bridge to more definitive treatment options. As more data develop, a shift toward a percutaneous approach with mechanical circulatory support may become a preferred option for the management of high-risk PE at tertiary care centers.
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Affiliation(s)
- Brett J Carroll
- Division of Cardiovascular Medicine (B.J.C., E.A.L., D.S.P., E.A.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Smith Center for Outcomes Research in Cardiology (B.J.C., J.G., E.A.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Emily A Larnard
- Division of Cardiovascular Medicine (B.J.C., E.A.L., D.S.P., E.A.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Duane S Pinto
- Division of Cardiovascular Medicine (B.J.C., E.A.L., D.S.P., E.A.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jay Giri
- Smith Center for Outcomes Research in Cardiology (B.J.C., J.G., E.A.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eric A Secemsky
- Division of Cardiovascular Medicine (B.J.C., E.A.L., D.S.P., E.A.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Smith Center for Outcomes Research in Cardiology (B.J.C., J.G., E.A.S.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Cardiovascular Medicine Division, Department of Medicine, University of Pennsylvania, Philadelphia (E.A.S.)
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4
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Hendley SA, Dimov A, Bhargava A, Snoddy E, Mansour D, Afifi RO, Wool GD, Zha Y, Sammet S, Lu ZF, Ahmed O, Paul JD, Bader KB. Assessment of histological characteristics, imaging markers, and rt-PA susceptibility of ex vivo venous thrombi. Sci Rep 2021; 11:22805. [PMID: 34815441 PMCID: PMC8610976 DOI: 10.1038/s41598-021-02030-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/08/2021] [Indexed: 12/27/2022] Open
Abstract
Venous thromboembolism is a significant source of morbidity and mortality worldwide. Catheter-directed thrombolytics is the primary treatment used to relieve critical obstructions, though its efficacy varies based on the thrombus composition. Non-responsive portions of the specimen often remain in situ, which prohibits mechanistic investigation of lytic resistance or the development of diagnostic indicators for treatment outcomes. In this study, thrombus samples extracted from venous thromboembolism patients were analyzed ex vivo to determine their histological properties, susceptibility to lytic therapy, and imaging characteristics. A wide range of thrombus morphologies were observed, with a dependence on age and etymology of the specimen. Fibrinolytic inhibitors including PAI-1, alpha 2-antiplasmin, and TAFI were present in samples, which may contribute to the response venous thrombi to catheter-directed thrombolytics. Finally, a weak but significant correlation was observed between the response of the sample to lytic drug and its magnetic microstructure assessed with a quantitative MRI sequence. These findings highlight the myriad of changes in venous thrombi that may promote lytic resistance, and imaging metrics that correlate with treatment outcomes.
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Affiliation(s)
- Samuel A Hendley
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA
| | - Alexey Dimov
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Aarushi Bhargava
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Erin Snoddy
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Daniel Mansour
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Rana O Afifi
- Department of Cardiothoracic and Vascular Surgery, University of Texas at Houston, Houston, TX, 77030, USA
| | - Geoffrey D Wool
- Department of Pathology, University of Chicago, Chicago, IL, 60637, USA
| | - Yuanyuan Zha
- The Human Immunological Monitoring Facility, University of Chicago, Chicago, IL, 60637, USA
| | - Steffen Sammet
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA.,Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Zheng Feng Lu
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA.,Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Osman Ahmed
- Department of Radiology, University of Chicago, Chicago, IL, 60637, USA
| | - Jonathan D Paul
- Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
| | - Kenneth B Bader
- Committee on Medical Physics, University of Chicago, Chicago, IL, 60637, USA. .,Department of Radiology, University of Chicago, Chicago, IL, 60637, USA.
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5
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Nezami N, Chockalingam A, Cornman-Homonoff J, Marino A, Pollak J, Mojibian H. Mechanical thrombectomy for pulmonary embolism in patients with patent foramen Ovale. CVIR Endovasc 2020; 3:89. [PMID: 33247349 PMCID: PMC7695793 DOI: 10.1186/s42155-020-00180-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited. Results This was a retrospective analysis of 9 patients with PFO and acute high-risk or intermediate-high-risk PE, 6 with intermediate-high risk and 3 with high-risk PE. All underwent MT using the Inari FlowTriever System from Dec 2018 to November 2019. Six of these patients had confirmed deep venous thrombosis. The technical and clinical success rate for MT in all patients was 100% and 77.8%, respectively. Right-heart strain improved in 6/8 patients on follow-up echocardiography. Mean main pulmonary artery (MPA) pressure significantly decreased after MT (p < 0.012). One patient presented with altered mental status (somnolence and disorientation) prior to coronary artery angiogram and thrombectomy, developed a middle cerebral artery embolic stroke 1 day after MT, and recovered with minor sequalae and later was discharged. There was no in-hospital mortality. Conclusions MT using FlowTriever was feasible and safe, successfully improving MPA pressure in patients presenting with concurrent PFO and PE.
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Affiliation(s)
- Nariman Nezami
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.,Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joshua Cornman-Homonoff
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Angelo Marino
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Jeffrey Pollak
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Hamid Mojibian
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
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6
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Brand J, McGowan R, Nimunkar A. Review of pulmonary emboli and techniques for their mechanical removal to inform device design. J Med Eng Technol 2020; 44:255-265. [PMID: 32657668 DOI: 10.1080/03091902.2020.1791985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Pulmonary emboli present a significant burden of disease, with limited treatment options for some patients. Mechanical devices for pulmonary emboli removal are becoming increasingly prevalent though more work remains to be done. This paper briefly discusses the mechanical properties of pulmonary emboli, the disease state they cause, and the existing embolectomy devices. The goal of this paper is to aid the design of minimally invasive mechanical pulmonary emboli removal devices, by providing a review of this topic as well as some key design specifications.
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Affiliation(s)
- Jessica Brand
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Roger McGowan
- Research and Development, Boston Scientific, Maple Grove, MN, USA
| | - Amit Nimunkar
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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7
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Abou Ali AN, Saadeddin Z, Chaer RA, Avgerinos ED. Catheter directed interventions for pulmonary embolism: current status and future prospects. Expert Rev Med Devices 2020; 17:103-110. [DOI: 10.1080/17434440.2020.1714432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Adham N. Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Zein Saadeddin
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rabih A. Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Efthymios D. Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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8
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Nezami N, Latich I, Murali N, Ali R, Lin BA, ShervinRad M, Pollak J, Mojibian H. Right Atrial and Massive Pulmonary Artery Mechanical Thrombectomy Under Echocardiography Guidance Using the FlowTriever System. EJVES Short Rep 2019; 45:22-25. [PMID: 31828229 PMCID: PMC6888743 DOI: 10.1016/j.ejvssr.2019.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/19/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022] Open
Abstract
Introduction Management of clot in transit in patients with pulmonary embolism, who are candidates for percutaneous intervention, can be challenging. This is a case report of simultaneous right atrial mechanical thrombectomy under echocardiography guidance and pulmonary artery embolectomy under fluoroscopy guidance, using the recently introduced FlowTriever system (Inari Medical Inc., Irvine, CA, USA). Report An 88 year old female, resuscitated from cardiopulmonary arrest near the end of a total right hip arthroplasty, presented for management of suspected massive pulmonary embolism. Her right atrial thrombus was removed under transthoracic echocardiography guidance, and her pulmonary arterial thrombus was subsequently successfully treated under fluoroscopy. Discussion The FlowTriever system can be safely and effectively used under real time transthoracic echocardiography guidance to retrieve clot in transit from the cardiac chambers, in addition to its standard application for the pulmonary artery under fluoroscopy guidance. FlowTriever system is recently cleared by FDA for mechanical thrombectomy of pulmonary embolism. This is the first case of mechanical thrombectomy in the right atrium or ventricle under echocardiography guidance. The mechanical thrombectomy in the right atrium/ventricle was safe and resolved the patient's symptoms.
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Affiliation(s)
- Nariman Nezami
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.,Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Igor Latich
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Nikitha Murali
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Rahmat Ali
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Ben A Lin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Jeffrey Pollak
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Hamid Mojibian
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
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9
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Wible BC, Buckley JR, Cho KH, Bunte MC, Saucier NA, Borsa JJ. Safety and Efficacy of Acute Pulmonary Embolism Treated via Large-Bore Aspiration Mechanical Thrombectomy Using the Inari FlowTriever Device. J Vasc Interv Radiol 2019; 30:1370-1375. [PMID: 31375449 DOI: 10.1016/j.jvir.2019.05.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/19/2019] [Accepted: 05/19/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To report initial experience with safety and efficacy in the treatment of pulmonary embolism (PE) using the FlowTriever device. MATERIALS AND METHODS A single-center retrospective study was performed in all patients with acute central PE treated using the FlowTriever device between March 2018 and March 2019. A total of 46 patients were identified (massive = 8; submassive = 38), all with right ventricular (RV) strain and 26% with thrombolytic contraindications. Technical success (according to SIR reporting guidelines) and clinical success (defined as mean pulmonary artery pressure intraprocedural improvement) are reported, as are major device and procedure-related complications within 30 days after discharge. RESULTS Technical success was achieved in 100% of cases (n = 46). Average mean pulmonary artery pressure improved significantly from before to after the procedure for the total population (33.9 ± 8.9 mm Hg before, 27.0 ± 9.0 mm Hg after; P < .0001; 95% confidence interval [CI], 5.0-8.8), submassive cohort (34.7 ± 9.1 mm Hg before, 27.4 ± 9.2 mm Hg after; P < .0001; 95% CI, 5.2-9.5) and massive cohort (30.4 ± 6.9 mm Hg before, 25.4 ± 8.2 mm Hg after; P < .05; 95% CI:0.4-9.6). Intraprocedural reduction in mean pulmonary artery pressure was achieved in 88% (n = 37 of 42). A total of 100% of patients (n = 46 of 46) survived to hospital discharge. In total, 71% of patients (n = 27 of 38) experienced intraprocedural reduction in supplemental oxygen requirements. Two major adverse events (4.6%) included hemoptysis requiring intubation, and procedure-related blood loss requiring transfusion. No delayed procedure-related complications or deaths occurred within 30 days of hospital discharge. CONCLUSIONS Initial clinical experience using the FlowTriever to perform mechanical thrombectomy showed encouraging trends with respect to safety and efficacy for the treatment of acute central, massive, and submassive pulmonary embolism.
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Affiliation(s)
- Brandt C Wible
- Saint Luke's Health System, Department of Radiology, Saint Luke's Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Jennifer R Buckley
- Saint Luke's Health System, Department of Radiology, Saint Luke's Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Kenneth H Cho
- Saint Luke's Health System, Department of Radiology, Saint Luke's Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Matt C Bunte
- Saint Luke's Mid America Heart Institute, Saint Luke's Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Nathan A Saucier
- Saint Luke's Health System, Department of Radiology, Saint Luke's Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - John J Borsa
- Saint Luke's Health System, Department of Radiology, Saint Luke's Hospital and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism. JACC Cardiovasc Interv 2019; 12:859-869. [DOI: 10.1016/j.jcin.2018.12.022] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022]
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Schultz J, Andersen A, Kabrhel C, Nielsen-Kudsk JE. Catheter-based therapies in acute pulmonary embolism. EUROINTERVENTION 2019; 13:1721-1727. [PMID: 29175770 DOI: 10.4244/eij-d-17-00437] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS To provide a systematic review of catheter-based therapies of acute pulmonary embolism. METHODS AND RESULTS Studies published in peer-reviewed journals before February 2017 were included and categorized according to the mechanism of thrombus removal: fragmentation, rheolytic therapy, aspiration or catheter-directed thrombolysis. Strengths, challenges and the level of evidence of each device were evaluated. We found 16 different catheter-based therapies for acute PE; all but one being used off-label. The majority of procedures involve catheter-directed thrombolysis. Aspiration therapy shows promise, but limited data are available. Rheolytic therapy should be used with caution, if at all, due to the high number of associated complications. CONCLUSIONS Catheter-based therapies show promise as a treatment for acute PE, though evidence is lacking. Further research into the efficacy and safety of devices is needed.
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Affiliation(s)
- Jacob Schultz
- Department of Cardiology, Aarhus University Hospital, Denmark
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12
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Javed QA, Sista AK. Endovascular therapy for acute severe pulmonary embolism. Int J Cardiovasc Imaging 2019; 35:1443-1452. [PMID: 30877411 DOI: 10.1007/s10554-019-01567-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/19/2019] [Indexed: 12/17/2022]
Abstract
Acute pulmonary embolism (PE) is a major public health problem and accounts for 100,000-180,000 deaths per year in the United States. Current prognostic stratification separates acute PE into massive, submassive, and low-risk by the presence or absence of sustained hypotension, RV dysfunction, and myocardial necrosis. Massive, submassive and low-risk PE have mortality rates of 25-65%, 3%, and < 1%, respectively. In this review we will focus on therapies currently available to manage acute massive and submassive PE.
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13
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Chiarello MA, Sista AK. Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism. Semin Intervent Radiol 2018; 35:122-128. [PMID: 29872248 DOI: 10.1055/s-0038-1642041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States. PE associated with right ventricular strain, termed submassive or intermediate-risk PE, is associated with an increased rate of clinical deterioration and short-term mortality. Trials have demonstrated systemic thrombolytics may improve patient outcomes, but they carry a risk of major hemorrhage. Catheter-directed thrombolysis (CDT) may offer similar efficacy to and a lower risk of catastrophic hemorrhage than systemic thrombolysis. Three prospective trials have evaluated CDT for submassive PE; ULTIMA, SEATTLE II, and PERFECT. These trials provide evidence that CDT may improve radiographic efficacy endpoints in submassive PE with acceptable rates of major hemorrhage. However, the lack of clinical endpoints, long-term follow-up, and adequate sample size limit their generalizability. Future trials should be adequately powered and controlled so that the short- and long-term effectiveness and safety of CDT can be definitively determined.
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Affiliation(s)
- Matthew A Chiarello
- Department of Radiology, New York University - Langone School of Medicine, New York, New York
| | - Akhilesh K Sista
- Division of Vascular and Interventional Radiology (VIR), Department of Radiology, New York University - Langone School of Medicine, New York, New York
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14
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Mohan B, Chhabra S, Verma A, Sidhu H, Goyal A, Singh B, Aslam N, Wander G. Catheter-based management of pulmonary embolism. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2018. [DOI: 10.4103/jpcs.jpcs_36_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Nosher JL, Patel A, Jagpal S, Gribbin C, Gendel V. Endovascular treatment of pulmonary embolism: Selective review of available techniques. World J Radiol 2017; 9:426-437. [PMID: 29354208 PMCID: PMC5746646 DOI: 10.4329/wjr.v9.i12.426] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/11/2017] [Accepted: 09/04/2017] [Indexed: 02/06/2023] Open
Abstract
Acute pulmonary embolism (PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.
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Affiliation(s)
- John L Nosher
- Division of Interventional Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Arjun Patel
- Division of Interventional Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Sugeet Jagpal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Christopher Gribbin
- Division of Interventional Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Vyacheslav Gendel
- Division of Interventional Radiology, Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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16
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Sista AK, Moriarty JM. The Future of Catheter-Directed Therapy: Data Gaps, Unmet Needs, and Future Trials. Tech Vasc Interv Radiol 2017; 20:224-226. [DOI: 10.1053/j.tvir.2017.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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17
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Zern EK, Young MN, Rosenfield K, Kabrhel C. A Pulmonary Embolism Response Team: initial experiences and future directions. Expert Rev Cardiovasc Ther 2017; 15:481-489. [PMID: 28571513 DOI: 10.1080/14779072.2017.1337509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Acute pulmonary embolism (PE) is a common cardiovascular condition resulting in significant morbidity and mortality. Consensus recommendations suggest risk stratification of patients into three main categories: high-risk or 'massive' PE, intermediate-risk or 'submassive' PE, and low-risk PE. Given the relative dearth of prospective, randomized clinical trials delineating optimal selection of the diverse medical, interventional, and surgical treatment approaches, clinical care requires a multidisciplinary expert approach to patients with PE. Areas covered: The Massachusetts General Hospital (MGH) Pulmonary Embolism Response Team (PERT) was the first of its kind to create a multidisciplinary, rapid response team for acute PE, integrated within a research and educational framework. The MGH PERT has treated more than 700 patients with PE, the majority of which are in the 'massive' or 'submassive' categories. The PERT Consortium™ was founded in 2015 as a collaborative network between the growing number of PERT programs internationally, with greater than 80 institutions participating within one year of establishment. Expert commentary: Since its advent, the PERT model has expanded throughout the United States and internationally through a collaborative institutional and research network. PERT may represent a new standard for the care of patients with acute PE.
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Affiliation(s)
- Emily K Zern
- a Department of Medicine , Massachusetts General Hospital , Boston , MA , USA
| | - Michael N Young
- b Section of Vascular Medicine, Division of Cardiology , Massachusetts General Hospital , Boston , MA , USA
| | - Kenneth Rosenfield
- b Section of Vascular Medicine, Division of Cardiology , Massachusetts General Hospital , Boston , MA , USA
| | - Christopher Kabrhel
- c Center for Vascular Emergencies, Department of Emergency Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
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