scholarly journals Acoustic pulse thrombolysis complemented by ECMO improved survival in patients with high‐risk pulmonary embolism

2022 ◽  
Author(s):  
Mert Dumantepe ◽  
Cuneyd Ozturk
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Acoustic Pulse

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.

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.

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.

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.

Renal function improves mortality prediction in acute pulmonary embolism: results of a multicentre cohort study with external validation in the RIETE registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Chopard ◽  
D Jimenez ◽  
G Serzian ◽  
F Ecarnot ◽  
N Falvo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Renal Function ◽  
High Risk ◽  
Renal Dysfunction ◽  
External Validation ◽  
Mortality Prediction ◽  
Model Fit ◽  
Funding Source ◽  
Risk Of Death ◽  
Acute Pe

Abstract Background Renal dysfunction may influence outcomes after pulmonary embolism (PE). We determined the incremental value of adding renal function impairment (estimated glomerular filtration rate, eGFR <60 ml/min/1.73m2) on top of the 2019 ESC prognostic model, for the prediction of 30-day all-cause mortality in acute PE patients from a prospective, multicenter cohort. Methods and results We identified which of three eGFR formulae predicted death most accurately. Changes in global model fit, discrimination, calibration and net reclassification index (NRI) were evaluated with addition of eGFR. We prospectively included consecutive adult patients with acute PE diagnosed as per ESC guidelines. Among 1,943 patients, (mean age 67.3±17.1, 50.4% women), 107 (5.5% (95% CI 4.5–6.5%)) died during 30-day follow-up. The eGFRMDRD4 formula was the most accurate for prediction of death. The observed mortality rate was higher for intermediate-low risk (OR 1.8, 95% CI 1.1–3.4) and high-risk PE (OR 10.3, 95% CI 3.6–17.3), and 30-day bleeding was significantly higher (OR 2.1, 95% CI 1.3–3.5) in patients with vs without eGFRMDRD4 <60 ml/min/1.73m2. The addition of eGFRMDRD4 information improved model fit, discriminatory capacity, and calibration of the ESC models. NRI was significantly improved (p<0.001), with 18% reclassification of predicted mortality, specifically in intermediate and high-risk PE. External validation using data from the RIETE registry confirmed our findings (Table). Conclusion Addition of eGFRMDRD4-derived renal dysfunction on top of the ESC prognostic algorithm yields significant reclassification of risk of death in intermediate and high-risk PE. Impact on therapy remains to be determined. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer Alliance, Bayer Healthcare

Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review

2020 ◽  
Vol 46 (08) ◽  
pp. 895-907
Author(s):  
Nina D. Anfinogenova ◽  
Oksana Y. Vasiltseva ◽  
Alexander V. Vrublevsky ◽  
Irina N. Vorozhtsova ◽  
Sergey V. Popov ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
High Risk ◽  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Right Atrial ◽  
Treatment Protocols ◽  
High Risk Patients ◽  
Risk Patients ◽  
The Right

AbstractPrompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

scholarly journals Catheter-directed low-dose fibrinolysis infusion for treat acute intermediate-high risk pulmonary embolism

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
MM Martin Cabeza ◽  
MJ Garcia Gonzalez ◽  
P Jorge Perez ◽  
A Sanchez-Grande Flecha ◽  
R Munoz Rodriguez ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
High Risk ◽  
Low Dose ◽  
Therapeutic Option ◽  
Bleeding Complications ◽  
Common Disease ◽  
Effective Treatment Option ◽  
Femoral Access ◽  
Rv Function

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND  Intermediate-high risk  (IHR) Pulmonary Embolism (PE) are a common disease witch could have a high mortality. Anticoagulation remains the first therapeutic option, but Catheter-directed therapies are being investigated as a safe and effective treatment option. PURPOSE To evaluate the safety and efficacy of Catheter-directed low-dose fibrinolysis infusion to treat IHR-PE. METHODS Retrospective analysis of 16 patients IHR-PE treated. After performing Right catheterization (RC) and angiogram, Pigtail catheters were located for intrapulmonary infusion of Alteplase 1mg/h/catheter for 24 h (25-30mg/day). Baseline and clinical characteristics, inicial and evolutive echocardiography, also clinical evaluation and echocardiography 6 months after discharge were evaluated.   RESULTS The majority were women (11) and obese (93.8%), aged 22-74 years with cardiovascular risk factors: 5 hypertension, 3 Dyslipidemia, 2 smokers and 3 severe CKD . At admission 11 patients consulted for dyspnea and 5 for syncope; all were hemodynamic stable. 68.8% presented respiratory failure. All had bilateral PE (angiography) and elevation of Nt-proBNP and troponins. The echocardiographic at admission, and its evolution are shown in Table 1.  The invasive measurement of pulmonary hypertension (PH) reflected greater severity than the estimated by echo:  5 (31.3%) Severe PH, 5 (31.3%) Moderate PH and 2 (12.5%) mild PH. At discharge all presented a decrease in PH and 15 (93.8%) improved RV function. 2 patients suffered bleeding complications (relation with femoral access): 1 not severe, 1 severe without mortality; none suffered intracranial hemorrhage. In the evaluation at 6-months: 13 patients (81.3%) where on functional Class I and without PH, 3 patients (18.8%) where in Class II and with mild-PH. CONCLUSION In short-term follow-up, intrapulmonary low-dose fibrinolysis reduces PA pressures and improves RV function, without an increased bleeding complications, especially if femoral access is avoided. However impact on long-term remains unclear. Table 1: Echocardiography evolution.RV function admissionNormal Function1 (6.3%)Mild Dysfunction9 (56.3%)Moderate Dysfunction6 (37.5%)RV Dilatation admissionDilatation 16 (100%)Not dilatation 0 (0%)PH Degree admissionMild PH6 (37.5%)Moderate PH5 (31.3%)Severe PH5 (31.3%)PH Degree 24h-postNot PH1 (6.3%)Mild PH10 (62.5%)Moderate/severe PH5 (31.3%)Improvement RV 24h-postYes14 (87.5%)Not2 (12.5%)RV function dischargeNormal Function16 (100%)Mild Dysfunction0 (0%)Moderate Dysfunction0 (0%)RV Dilatation dischargeDilatation 5 (31.3%)Not dilatation 11 (68.8%)PH Degree dischargeNot PH 9 (56.3%)Mild PH7 (43.8%)Moderate/severe PH0 (0%)RV Right Ventricular; PH: Pulmonary Hypertension,

scholarly journals CRT-300.08 High-risk Pulmonary Embolism Thrombectomy Using 8fr Judkins Right Guiding Coronary Catheter (Urgent, Cheaper And Feasible)

2017 ◽  
Vol 10 (3) ◽  
pp. S42
Author(s):  
Luis Enrique Berumen Dominguez ◽  
Hugo Gutierrez Leonard ◽  
Anton Meneses Bonilla ◽  
Ricardo Aguilar-oliva
Keyword(s):  
Pulmonary Embolism ◽  
High Risk

scholarly journals Early, real-world experience with direct oral anticoagulants in the treatment of intermediate-high risk acute pulmonary embolism

2017 ◽  
Vol 36 (11) ◽  
pp. 801-806
Author(s):  
Sónia Martins Santos ◽  
Susana Cunha ◽  
Rui Baptista ◽  
Sílvia Monteiro ◽  
Pedro Monteiro ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Real World ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants
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