scholarly journals What's next after the clot? Residual pulmonary vascular obstruction after pulmonary embolism: From imaging finding to clinical consequences

2019 ◽  
Vol 184 ◽  
pp. 67-76 ◽  
Author(s):  
P.B. Bonnefoy ◽  
V. Margelidon-Cozzolino ◽  
J. Catella-Chatron ◽  
E. Ayoub ◽  
J.B. Guichard ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Imaging Finding ◽  
Clinical Consequences ◽  
Vascular Obstruction ◽  
Pulmonary Vascular Obstruction

Ultrasound-Assisted Catheter-Directed Thrombolysis for Submassive Pulmonary Embolism

2018 ◽  
Vol 52 (3) ◽  
pp. 195-201 ◽  
Author(s):  
Prasoon P. Mohan ◽  
John J. Manov ◽  
Francisco Contreras ◽  
Michael E. Langston ◽  
Mehul H. Doshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Bleeding Risk ◽  
Right Heart ◽  
Systemic Thrombolysis ◽  
Catheter Directed Thrombolysis ◽  
Ultrasound Assisted ◽  
Vascular Obstruction ◽  
The Right ◽  
Pulmonary Vascular Obstruction

Purpose: Catheter-directed thrombolysis (CDT) is a relatively new therapy for pulmonary embolism that achieves the superior clot resolution compared to systemic thrombolysis while avoiding the high bleeding risk intrinsically associated with that therapy. In order to examine the efficacy and safety of CDT, we conducted a retrospective cohort study of patients undergoing ultrasound-assisted CDT at our institution. Methods: The charts of 30 consecutive patients who underwent CDT as a treatment of pulmonary embolism at our institution were reviewed. Risk factors for bleeding during thrombolysis were noted. Indicators of the right heart strain on computed tomography and echocardiogram, as well as the degree of pulmonary vascular obstruction, were recorded before and after CDT. Thirty-day mortality and occurrence of bleeding events were recorded. Results: Nine (30%) patients had 3 or more minor contraindications to thrombolysis and 14 (47%) had major surgery in the month prior to CDT. Right ventricular systolic pressure and vascular obstruction decreased significantly after CDT. There was a significant decrease in the proportion of patients with right ventricular dilation or hypokinesis. Decrease in pulmonary vascular obstruction was associated with nadir of fibrinogen level. No patients experienced major or moderate bleeding attributed to CDT. Conclusion: Catheter-directed thrombolysis is an effective therapy in rapidly alleviating the right heart strain that is associated with increased mortality and long-term morbidity in patients with pulmonary embolism with minimal bleeding risk. Catheter-directed thrombolysis is a safe alternative to systemic thrombolysis in patients with risk factors for bleeding such as prior surgery. Future studies should examine the safety of CDT in patients with contraindications to systemic thrombolysis.

scholarly journals Dead Space Ventilation Parallels Changes in Scintigraphic Vascular Obstruction at Recurrence of Pulmonary Embolism and after Thrombolytic Therapy: A Case Report

1998 ◽  
Vol 5 (3) ◽  
pp. 215-218 ◽  
Author(s):  
Marc A Rodger ◽  
Gwynne Jones ◽  
Francois Raymond ◽  
Daniel Lalonde ◽  
Mike Proulx ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Dead Space ◽  
Heparin Therapy ◽  
Alveolar Dead Space ◽  
Right Heart ◽  
Vascular Obstruction ◽  
Right Heart Dysfunction ◽  
Pulmonary Vascular Obstruction ◽  
Dead Space Ventilation

Physiological and alveolar dead space ventilation both increase in pulmonary embolism (PE) in proportion to the severity of vascular obstruction. The case of a patient with recurrent PE while on heparin therapy is presented. The recurrence was characterized clinically by severe pulmonary vascular obstruction and right heart dysfunction. The patient was treated with thrombolytic therapy, with excellent clinical and scintigraphic resolution. Dead space ventilation measurements at baseline, at the time of recurrence and after thrombolytic therapy are presented. The potential utility of dead space ventilation measurements for PE diagnosis and management are discussed.

Detection of Residual Pulmonary Vascular Obstruction by Ventilation-Perfusion Lung Scan Late After a First Pulmonary Embolism

2017 ◽  
Vol 119 (11) ◽  
pp. 1883-1889 ◽  
Author(s):  
Romain Chopard ◽  
Bruno Genet ◽  
Fiona Ecarnot ◽  
Marion Chatot ◽  
Gabriel Napporn ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Lung Scan ◽  
Vascular Obstruction ◽  
Pulmonary Vascular Obstruction

Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism. A single center cohort study

2016 ◽  
Vol 148 ◽  
pp. 70-75 ◽  
Author(s):  
Benjamin Planquette ◽  
Alexis Ferré ◽  
Julien Peron ◽  
Amandine Vial-Dupuy ◽  
Jean Pastre ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cohort Study ◽  
Acute Pulmonary Embolism ◽  
Single Center ◽  
Vascular Obstruction ◽  
Pulmonary Vascular Obstruction

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

2021 ◽  
Author(s):  
Charles Orione ◽  
Cécile Tromeur ◽  
Raphael Le Mao ◽  
Pierre-Yves Le Floch ◽  
Philippe Robin ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Prospective Cohort ◽  
Independent Risk Factor ◽  
Risk Of Recurrence ◽  
Lung Scan ◽  
Vascular Obstruction ◽  
Pulmonary Vascular Obstruction ◽  
Risk Factor For Recurrence

Abstract Background We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE). Study Design and Methods French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation. Results A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2–6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20–2.62, p < 0.01), whether PE was provoked by a major transient risk factor or not. A threshold at 41% was identified as the best value associated with the risk of recurrence 6 months after stopping anticoagulation (area under curve = 0.64). Conclusion PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.

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