scholarly journals 1: MECHANICAL THROMBECTOMY IMPROVES CARDIAC INDEX IN PULMONARY EMBOLISM PATIENTS IN SUBCLINICAL SHOCK

2021 ◽  
Vol 50 (1) ◽  
pp. 1-1
Author(s):  
Bushra Mina
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Index ◽  
Mechanical Thrombectomy

scholarly journals Initial Experience with the Flowtriever Mechanical Thrombectomy Device for Pulmonary Embolism

2021 ◽  
Vol 73 (3) ◽  
pp. 46-47
Author(s):  
Hunter M. Ray ◽  
Alejandro Pizano ◽  
Naveed U. Saqib ◽  
Stuart A. Harlin
Keyword(s):  
Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Initial Experience ◽  
Thrombectomy Device

scholarly journals MASSIVE PULMONARY EMBOLISM TREATED WITH PERCUTANEOUS MECHANICAL THROMBECTOMY

2021 ◽  
Vol 77 (18) ◽  
pp. 2803
Author(s):  
Radhika Deshpande ◽  
Basma Al-Bast ◽  
Mukul Bhattarai ◽  
Abhishek Kulkarni ◽  
Prashant Jagtap
Keyword(s):  
Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Massive Pulmonary Embolism ◽  
Percutaneous Mechanical Thrombectomy

Abstract P673: The Obesity Paradox in Patients Hospitalized for Ischemic Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Genaro Velazquez ◽  
Hafeez Shaka ◽  
Hernan G. Marcos-Abdala ◽  
Emmanuel Akuna
Keyword(s):  
Pulmonary Embolism ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Length Of Hospital Stay ◽  
Obesity Paradox ◽  
Secondary Outcomes

Introduction: Even though Obesity, as measured by BMI > 30.00 kg/m 2 , is a established risk factor for ASCVD, it hasn’t been proven as a risk factor for adverse outcomes in patients with diagnosis of ischemic stroke. Our study sought to compare outcomes for ischemic stroke hospitalizations in patients with and without Obesity. Methods: A retrospective cohort study was conducted using the Nationwide Inpatient Sample from 2016 and 2017. About 71,473,874who had ischemic stroke as primary diagnosis were enrolled and further stratified based on the presence or absence of Obesity as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality and secondary outcomes included length of hospital stay, treatment with mechanical thrombectomy, treatment with tPA, and complications like respiratory failure requiring intubation, pulmonary embolism (PE), DVT, NSTEMI and sepsis. Multivariate regression analysis was done to adjust for confounders. Results: The in-hospital mortality for patients with ischemic stroke was 42 145 overall. Compared with patients without obesity, patients with Obesity had a lower odds of in- hospital mortality (aOR 0.85, 95% CI 0.79-0.93, p<0.001) when adjusted for patient and hospital characteristics. We found that patients with ischemic stroke and obesity had decreased length of hospital stay and higher odds ratio of treatment with mechanical thrombectomy, treatment with tPA, and higher odds ratio of complications like respiratory failure requiring intubation and pulmonary embolism (PE). No significant difference in other secondary outcomes (DVT, NSTEMI and sepsis). Conclusion: There is convincing evidence supporting the existence of the “obesity paradox” in patients with ischemic stroke. Several stroke-associated mechanisms, like autonomous nervous activation and pro-inflammatory cytokine release in addition to other factors like impaired feeding and inactivity cause accelerated tissue degradation and overall weight loss. It is thought that obese patients with better metabolic reserve may be less affected from this unfavorable metabolic dysregulation as compared to underweight patients. Nevertheless, further studies are needed in order to identify factors responsible for this paradox.

scholarly journals OLD DOG, NEW TRICK: NOVEL CT-DERIVED PARAMETER IS ASSOCIATED WITH LOW CARDIAC INDEX IN ACUTE PULMONARY EMBOLISM

2020 ◽  
Vol 75 (11) ◽  
pp. 2273
Author(s):  
Yevgeniy Brailovsky ◽  
Dalila Masic ◽  
Vladimir Lakhter ◽  
Fredrik Wexels ◽  
Sorcha Allen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Index ◽  
Acute Pulmonary Embolism

scholarly journals A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism

2019 ◽  
Vol 12 (9) ◽  
pp. 859-869 ◽  
Author(s):  
Thomas Tu ◽  
Catalin Toma ◽  
Victor F. Tapson ◽  
Christopher Adams ◽  
Wissam A. Jaber ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Multicenter Trial ◽  
Intermediate Risk

scholarly journals Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Aleksander Araszkiewicz ◽  
Sylwia Sławek-Szmyt ◽  
Stanisław Jankiewicz ◽  
Bartosz Żabicki ◽  
Marek Grygier ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Low Dose ◽  
Mechanical Thrombectomy ◽  
Arterial Oxygen Saturation ◽  
Clinical Status ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Arterial Oxygen ◽  
Pulmonary Artery Systolic Pressure

Objectives. We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results. Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients’ clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p < 0.0001 ), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p = 0.049 ), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p = 0.0051 ), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p = 0.0015 ), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p < 0.0001 ) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p < 0.0001 ). No major periprocedural bleeding was detected. Conclusions. CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation.

scholarly journals Right Ventricular Outflow Doppler Predicts Low Cardiac Index in Intermediate Risk Pulmonary Embolism

2019 ◽  
Vol 25 ◽  
pp. 107602961988606 ◽  
Author(s):  
Yevgeniy Brailovsky ◽  
Vladimir Lakhter ◽  
Ido Weinberg ◽  
Katerina Porcaro ◽  
Jeremiah Haines ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Index ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Intermediate Risk ◽  
Velocity Time Integral ◽  
Time Integral ◽  
Related Mortality

Intermediate-risk pulmonary embolism (PE) has variable outcomes. Current risk stratification models lack the positive predictive value to identify patients at highest risk of PE-related mortality. We identified intermediate-risk PE patients who underwent catheter-based interventions and right heart catheterization (RHC) and identified those with low cardiac index (CI < 2.2 L/min/m2). We utilized regression models to identify echocardiographic predictors of low CI and Kaplan Meier curve to evaluate PE-related mortality when stratified by the echocardiographic predictor. Of 174 intermediate-risk PE patients, 41 underwent RHC. Within this cohort, 46.3% had low CI. Univariable linear regression identified right ventricular outflow tract velocity time integral (RVOT VTI), right/left ventricular ratio, S prime, inferior vena cava diameter, and pulmonary artery systolic pressure as potential predictors of low CI. Multivariable linear regression identified RVOT VTI as significant predictor of low CI (β coefficient 0.124, 95% confidence interval [CI]: 0.01-0.24, P = .034). Right ventricular outflow tract velocity time integral <9.5 cm was associated with increased PE-related mortality, P = .002. A substantial proportion of intermediate-risk PE patients referred for catheter-based interventions had low CI despite normotension. Right ventricular outflow tract velocity time integral was a significant predictor of low CI. Low RVOT VTI was associated with increased PE-related mortality.

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