scholarly journals Successful treatment of right heart thrombus and high‐risk pulmonary embolism with acoustic pulse thrombolysis using EKOS endovascular system

2021 ◽  
Author(s):  
Cuneyt Ozturk ◽  
Mert Dumantepe
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Successful Treatment ◽  
Acoustic Pulse ◽  
Right Heart

scholarly journals Successful Treatment of Right Heart Thrombus and High-Risk Pulmonary Embolism with Acoustic Pulse Thrombolysis Using EKOS Endovascular System

2021 ◽  
Author(s):  
Cuneyd Ozturk ◽  
Mert Dumantepe
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Acoustic Pulse ◽  
Prognostic Indicator ◽  
Hemodynamic Instability ◽  
Interventional Treatment ◽  
Atrial Thrombus ◽  
Right Heart ◽  
Catheter Directed Thrombolysis ◽  
Progressive Dyspnea

Currently, the only widely accepted indication for interventional treatment in cases of pulmonary embolism is hemodynamic instability or cardiogenic shock. However, the presence of a right-heart thrombus along with a pulmonary embolism is a poor prognostic indicator, and catheter-directed thrombolysis with the use of thrombolytic agents should also be considered in this circumstance. Optimal management of right heart thrombus and high-risk pulmonary embolism is still uncertain. Herein, we present the case of an 81-year-old woman who presented at our hospital after progressive dyspnea and a syncopal event. The transthoracic echocardiography showed massive bilateral pulmonary, right ventricular, and mobile atrial thrombus and also right-sided enlargement. The patient was successfully treated with acoustic pulse thrombolysis using the EKOS EkoSonic system and echocardiography revealed complete resolution of her right-heart thrombus and her high-risk pulmonary embolism 2 days later.

scholarly journals Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis

2020 ◽  
Author(s):  
Fernando Scudiero ◽  
Antonino Pitì ◽  
Roberto Keim ◽  
Guido Parodi
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Retrospective Studies ◽  
Right Heart ◽  
Clinical Issue ◽  
Systemic Thrombolysis ◽  
Case Summary ◽  
High Prevalence ◽  
Life Threatening ◽  
Complex Scenario

Abstract Background Despite the fast-growing understanding of the coronavirus disease 2019 (COVID-19), patient management remains largely empirical or based on retrospective studies. In this complex scenario, an important clinical issue appears to be represented by the high prevalence of thromboembolic events, but the data regarding high-risk pulmonary embolism (PE) is still not available. Case summary A patient with COVID-19 developed sudden shortness of breath and hypoxia. Early echocardiographic diagnosis of high-risk PE related to right heart thrombus was performed. Systemic thrombolysis was administered with excellent clinical and haemodynamic response. Discussion Pulmonary thromboembolism is a common occurrence in severe COVID-19 infection. In our experience, systemic thrombolysis proved to be effective and for this reason may be considered for life-threatening PE in COVID-19 patients.

Successful treatment of intermediate-high–risk pulmonary embolism with aspiration thrombectomy: first experience in Poland

2018 ◽  
pp. 1381-1381 ◽  
Author(s):  
Marek Roik ◽  
Dominik Wretowski ◽  
Michał Machowski ◽  
Michał Ciurzyński ◽  
Marcin Krakowian ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Successful Treatment ◽  
Aspiration Thrombectomy

scholarly journals High-risk pulmonary embolism with right heart thrombi

2012 ◽  
Vol 31 (5) ◽  
pp. 399-400
Author(s):  
F.átima Saraiva ◽  
Isabel Fonseca ◽  
Rui Martins ◽  
Lino Gonçalves ◽  
Luís Augusto Providência
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Right Heart

Prognostic significance of free-floating right heart thromboemboli in acute pulmonary embolism

2014 ◽  
Vol 111 (01) ◽  
pp. 53-57 ◽  
Author(s):  
Cecilia Becattini ◽  
Emanuele Guglielmelli ◽  
Irene Floriani ◽  
Vincenzo Morrone ◽  
Carla Caponi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Univariate Analysis ◽  
Prognostic Significance ◽  
Low Risk ◽  
Risk Category ◽  
Intermediate Risk ◽  
Right Heart ◽  
Risk Of Death ◽  
Risk Patients

SummaryThe exact prevalence of mobile right heart thromboemboli (RHTh) in patients with pulmonary embolism (PE) is unknown, depending upon PE severity and the use of early echocardiography. Similarly, the mortality rate is variable, though RHTh detection appears to substantially increase the risk of death in patients with PE. The aim of this study was to assess the prevalence of RHTh in different risk categories in a wide series of patients with PE, and to analyse the effect of RHTh on in-hospital mortality. Among 1,716 patients enrolled in the Italian Pulmonary Embolism Registry, 1,275 (13.3% at high risk, 59.3% at intermediate risk and 27.4% at low risk) had echocardiography within 48 hours from hospital admission and entered the study. Overall, RHTh were detected in 57 patients (4.5%, at admission echocardiography in 88%): in 27/169 (16%) high-risk, in 29/756 (3.8%) intermediate-risk and 1/350 (0.3%) low-risk patients, respectively. At multivariate analysis, only advanced age (odds ratio [OR] 1.61, 95% confidence [CI] 1.27–2.03, p<0.0001), high-risk category (OR vs low-risk category 37.82, 95% CI 11.26–127.06, p<0.0001) and recurrent PE (OR 45.92, 95%CI 15.19–139.96, p<0.0001) showed a statistically significant effect on mortality. The presence of RHTh significantly increased the risk of dying (OR 3.89, 95%CI 1.98–7.67, p=0.0001) at univariate analysis, but this result was not mantained in the multivariate model (OR 1.64, 95%CI 0.75–3.60, p=0.216). In conclusion, though patients with RHTh had a more severe presentation of PE, this study did not detect an association between RHTh and prognosis.

scholarly journals Acoustic Pulse Thrombolysis Complemented by ECMO Improved Survival in Patients with High-Risk Pulmonary Embolism

2021 ◽  
Author(s):  
Mert Dumantepe ◽  
Cuneyd Ozturk
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
High Risk ◽  
Acoustic Pulse ◽  
Length Of Hospital Stay ◽  
Right Ventricular Dysfunction ◽  
High Morbidity ◽  
Refractory Shock ◽  
Tissue Plasminogen ◽  
The Mean

Background: The optimal treatment of high-risk PE with cardiac arrest is still controversial although various treatment approaches have been developed and improved. Here, we present a serie of patients with high-risk PE showing hemodynamic collapse, who were successfully treated with extracorporeal membrane oxygenation (ECMO) as an adjunct to EKOS™ acoustic pulse thrombolysis. Method: From April 2016 to June 2020, 29 patients with high-risk PE with cardiac arrest were retrospectively included. The mean age was 55.3 ± 9.2 years. Twelve (41.3%) patients were female. All patients had cardiac arrest, either as an initial presentation or in-hospital after the presentation. All patients exhibited acute symptoms, computed tomography (CT) evidence of large thrombus burden, and severe right ventricular dysfunction. Primary outcome was all-cause 30-day mortality. Results: Twenty-two patients survived to hospital discharge, with a mean ICU stay of 9.9 ± 1.6 days (range, 7 to 22 days) and mean length of hospital stay of 23.7 ± 8.5 days (range, 11 to 44 days). Six patients died from refractory shock. Ninety-day mortality was 24.1% (7/29). The Mean ECMO duration was 3.5 ± 1.1 days and the mean RV/LV ratio decreased from 1.31 ± 0.17 to 0.92 ± 0.11 in patients who survived to discharge. The mean tissue plasminogen activator (tPA) dose for survivor patients was 20.5 ± 1.6 mg. Conclusion: Patients with high-risk pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. APT complemented by ECMO could be a successful treatment option for patients who have high-risk PE with circulatory collapse.

COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 333-337 ◽  
Author(s):  
Francisco Leonardo Galastri ◽  
Leonardo Guedes Moreira Valle ◽  
Breno Boueri Affonso ◽  
Marcela Juliano Silva ◽  
Rodrigo Gobbo Garcia ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Dynamic Process ◽  
Therapeutic Option ◽  
Massive Pulmonary Embolism ◽  
Percutaneous Intervention ◽  
Thromboembolic Events ◽  
Emergency Center ◽  
Catheter Directed Thrombolysis

Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

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