Novel Pharmacomechanical Thrombolysis for Treating Intermediate-Risk Acute Pulmonary Embolism: The Bashir Endovascular Catheter

Abstract BackgroundAcute pulmonary embolism (APE) is a life-threatening disease with nonspecific clinical signs and symptoms. Rapid and accurate diagnosis is crucial for the clinical management of patients with acute pulmonary embolism. A new recommended echocardiography view may be of further help in the diagnosis, evaluate the change of the thrombosis and treatment effect.Case presentationWe report a case of a 74-year-old man with a 12-day history of decreased exercise capacity and dyspnoea. The patient was diagnosed intermediate-risk APE as several pulmonary emboli in pulmonary artery were seen in multidetector computed tomographic pulmonary angiography with normal blood pressure and echocardiographic right ventricular overload. And we found a pulmonary artery clot in the right pulmonary artery through transthoracic echocardiography. After 11-days anticoagulation, the patient underwent a reassessment, showed decrease in RV diameter and pulmonary artery thrombus. ConclusionThis case highlights the significant role that echocardiography played in a patient who presented pulmonary embolism with a stable hemodynamic situation and normal blood pressure. The new echocardiographic view could provide correct diagnoses by identifying the clot size and location visually. Knowledge of the echocardiography results of APE would aid the diagnosis.

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

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2018.12.022 ◽

2019 ◽

Vol 12 (9) ◽

pp. 859-869 ◽

Cited By ~ 58

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

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Surgical embolectomy for intermediate-risk acute pulmonary embolism

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivu376 ◽

2014 ◽

Vol 20 (2) ◽

pp. 274-275

Author(s):

Sébastien Champion ◽

Eric Braunberger

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Intermediate Risk ◽

Surgical Embolectomy

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P5588Early versus delayed oral anticoagulation in patients with acute pulmonary embolism: determinants and outcome

European Heart Journal ◽

10.1093/eurheartj/ehz746.0532 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Becattini ◽

L A Cimini ◽

M Lankeit ◽

P Pruszczyk ◽

S Vanni ◽

...

Keyword(s):

Pulmonary Embolism ◽

Oral Anticoagulation ◽

Acute Pulmonary Embolism ◽

Oral Anticoagulants ◽

Hospital Death ◽

Intermediate Risk ◽

Right Ventricle Dysfunction ◽

Risk Of Death ◽

Risk Patients ◽

Acute Pe

Abstract Background Whether early oral anticoagulant treatment is appropriate for patients with acute pulmonary embolism (PE) regardless of PE severity is undefined. The aim of this study in patients with acute PE at intermediate risk of death were: I) to assess the determinants for the use of early vs delayed vs no oral anticoagulants in patients with acute PE and II) to assess the association between timing of oral anticoagulation and in-hospital mortality. Methods Prospective cohorts of patients with acute PE at intermediate risk of death according to the European Society of Cardiology Guidelines 2014 were merged in a collaborative database. The initiation of oral anticoagulation was classified as early (≤3 days) or delayed (between day 3 and 10 from diagnosis). Patients treated with parenteral anticoagulants for longer than 10 days were also included. In-hospital death was the primary study outcome. Results Overall, 557 patients were included in the study, 23 received thrombolytic treatment during the hospital stay. The mean duration of parenteral anticoagulation was 7±8 days (5 median), 348 patients were initiated on a direct oral anticoagulant and 79 on a vitamin K antagonist during the hospital stay. Initiation of oral anticoagulants occurred early or delayed in 209 (37%) and 218 (39%) patients, respectively and never occurred during the first 30 days in 130 (23%). Intermediate-low risk patients more commonly received early and intermediate high delayed oral anticoagulation. Simplified PESI score of zero (OR 1.9, 95% CI 1.3–2.7) was independently associated with early oral anticoagulation; among sPESI components absence of cancer (OR 5.9, 95% CI 3.3–10) and heart rate <110 (OR 1.8, 95% CI 1.01–3.16) were independent predictors of early initiation of oral anticoagulants. The presence of both right ventricle dysfunction and injury was associated with delayed initiation of oral anticoagulants. The incidence of death was 5.5%. Death occurred in 32 patients and was not related to the duration of parenteral anticoagulation (OR 1.01 per day, 95% CI 0.98–1.06) nor to right ventricle dysfunction but to sPESI 1 (OR 3.32, 95% CI 1.14–9.66). These results were partially confirmed in the 435 intermediate risk patients without cancer (OR 1.03, 95% CI 0.99–1.08 for days of parenteral treatment; OR 4.17, 95% CI 0.95–18 for sPESI 1). Conclusion The clinical severity of PE and not the timing of initiation of oral anticoagulants are associated with in-hospital death in patients with intermediate risk PE. Randomized studies are needed to definitively assess the role of heparin lead-in in patients with PE at intermediate risk for death.

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e0576 Clinical Analysis of Anticoagulant Treatment in Acute Pulmonary Embolism Stratified as Intermediate-risk

Heart ◽

10.1136/hrt.2010.208967.576 ◽

2010 ◽

Vol 96 (Suppl 3) ◽

pp. A178-A178

Author(s):

W. Yong ◽

Z. Hongliang

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Clinical Analysis ◽

Intermediate Risk ◽

Anticoagulant Treatment

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Midterm outcomes of catheter-directed interventions for the treatment of acute pulmonary embolism

Vascular ◽

10.1177/1708538116654638 ◽

2016 ◽

Vol 25 (2) ◽

pp. 130-136 ◽

Cited By ~ 6

Author(s):

Nathan L Liang ◽

Rabih A Chaer ◽

Luke K Marone ◽

Michael J Singh ◽

Michel S Makaroun ◽

...

Keyword(s):

Pulmonary Embolism ◽

Large Scale ◽

Acute Pulmonary Embolism ◽

Treatment Time ◽

Clinical Success ◽

Interventional Therapy ◽

Bleeding Complications ◽

Intermediate Risk ◽

Catheter Directed Thrombolysis ◽

One Year

Objective The hemodynamic benefits of catheter-directed thrombolysis for acute pulmonary embolism have not been clearly defined beyond the periprocedural period. The objective of this study is to report midterm outcomes of catheter-directed thrombolysis for treatment of acute pulmonary embolism. Methods Records of all patients undergoing catheter-directed thrombolysis for high- or intermediate-risk pulmonary embolism were retrospectively reviewed. Endpoints were clinical success, procedure-related complications, mortality, and longitudinal echocardiographic parameter improvement. Results A total of 69 patients underwent catheter-directed thrombolysis (mean age 59 ± 15 y, 56% male). Eleven had high-risk and 58 intermediate-risk pulmonary embolism. Baseline characteristics did not differ by pulmonary embolism subtype. Fifty-two percent of patients underwent ultrasound-assisted thrombolysis, 39% standard catheter-directed thrombolysis, and 9% other interventional therapy; 89.9% had bilateral treatment. Average treatment time was 17.7 ± 11.3 h with average t-Pa dose of 28.5 ± 19.6 mg. The rate of clinical success was 88%. There were two major (3%) and six minor (9%) periprocedural bleeding complications with no strokes. All echocardiographic parameters demonstrated significant improvement at one-year follow-up. Pulmonary embolism-related in-hospital mortality was 3.3%, and estimated survival was 81.2% at one year. Conclusions Catheter-directed thrombolysis is safe and effective for treatment of acute pulmonary embolism, with sustained hemodynamic improvement at one year. Further prospective large-scale studies are needed to determine comparative effectiveness of interventions for acute pulmonary embolism.

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Risk stratification in intermediate-risk acute pulmonary embolism

Journal of Critical Care ◽

10.1016/j.jcrc.2016.06.015 ◽

2016 ◽

Vol 36 ◽

pp. 292

Author(s):

Murat Biteker ◽

Volkan Doğan ◽

Özcan Başaran ◽

Marwa Mouline Doğan

Keyword(s):

Pulmonary Embolism ◽

Risk Stratification ◽

Acute Pulmonary Embolism ◽

Intermediate Risk

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Inhaled nitric oxide has pulmonary vasodilator efficacy both in the immediate and prolonged phase of acute pulmonary embolism

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620918713 ◽

2020 ◽

pp. 204887262091871 ◽

Cited By ~ 1

Author(s):

Anders Kramer ◽

Christian Schmidt Mortensen ◽

Jacob Gammelgaard Schultz ◽

Mads Dam Lyhne ◽

Asger Andersen ◽

...

Keyword(s):

Nitric Oxide ◽

Pulmonary Embolism ◽

Right Ventricular ◽

Acute Pulmonary Embolism ◽

Porcine Model ◽

Inhaled Nitric Oxide ◽

Intermediate Risk ◽

Ventricular Afterload ◽

Pulmonary Vasodilator ◽

Acute Pe

Background Inhaled nitric oxide (iNO) effectively reduces right ventricular afterload when administered in the immediate phase of acute pulmonary embolism (PE) in preclinical animal models. In a porcine model of intermediate-risk PE, we aimed to investigate whether iNO has pulmonary vasodilator efficacy both in the immediate and prolonged phase of acute PE. Methods Anesthetized pigs ( n = 18) were randomized into three subgroups. An acute PE iNO-group ( n = 6) received iNO at 40 ppm at one, three, six, nine and 12 hours after onset of PE. Vehicle animals ( n = 6) received PE, but no active treatment. A third group of sham animals ( n = 6) received neither PE nor treatment. Animals were evaluated using intravascular pressures, respiratory parameters, biochemistry and intracardiac pressure-volume measurements. Results The administration of PE increased mean pulmonary artery pressure (mPAP) (vehicle vs sham; 33.3 vs 17.7 mmHg, p < 0.0001), pulmonary vascular resistance (vehicle vs sham; 847.5 vs 82.0 dynes, p < 0.0001) and right ventricular arterial elastance (vehicle vs sham; 1.2 vs 0.2 mmHg/ml, p < 0.0001). Significant mPAP reduction by iNO was preserved at 12 hours after the onset of acute PE (vehicle vs iNO; 0.5 vs –3.5 mmHg, p < 0.0001). However, this response was attenuated over time ( p = 0.0313). iNO did not affect the systemic circulation. Conclusions iNO is a safe and effective pulmonary vasodilator both in the immediate and prolonged phase of acute PE in an in-vivo porcine model of intermediate-risk PE.

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