Background:
Catheter-based treatments (CBTs) are diverse set of techniques aimed at relieving pulmonary arterial obstruction in patients with high-risk pulmonary embolism. Multiple modalities are currently available. The mortality and safety outcomes have not been studied among these different modalities.
Hypothesis:
We conducted this investigation to determine the mortality and safety of individual modalities.
Methods:
We searched SCOPUS since inception to November 2014 using predefined criteria. Studies including massive PE or a combination of massive and submassive PE, as defined by the American Heart Association, were included. In-hospital mortality rates and pooled safety complication rate (defined as a composite of peri- and post-procedural cardiac arrest, minor access site bleeding, major access site bleeding, and bleeding at other sites) were estimated using standard meta-analytic methods and compared among six different groups namely aspiration thrombectomy, intrapulmonary thrombolysis (IP), mechanical fragmentation (MF), rheolytic thrombectomy (RT), ultrasound-accelerated thrombolysis (USAT) and multiple simultaneous modalities.
Results:
In 54 eligible studies with 1,333 patients, 1,357 CBT procedures were performed. Patients undergoing USAT had the lowest in-hospital mortality rate whereas patients undergoing RT had the highest in-hospital mortality rate (p = 0.011, Table). Intrapulmonary thrombolysis had the highest pooled rate of safety outcome whereas MF had the lowest rate among various techniques (p = 0.034, Table).
Conclusion:
There is significant heterogeneity in mortality and safety outcomes between various CBT modalities. Our analysis is limited by variance in study quality and baseline characteristics. More investigation is required to determine the optimal type of CBT for high-risk PE.
Large-Bore Aspiration Thrombectomy: Catalyst for a Revolution in Treating Pulmonary Embolism
