Interventionelle Therapie der Lungenembolie – aktueller Stand

Was ist neu?

Evidenz der systemischen Lysetherapie als Standardverfahren zur Rekanalisation Die Evidenz der systemischen Lysetherapie in High- und Intermediate-High-Lungenembolien ist niedrig. Ohne rekanalisierende Maßnahmen führt die Rechtsherz-Dekompensation in High- und Intermediate-High-Risk-Lungenembolien oft zum Tod.

Kathetergestützte Techniken In den letzten Jahren wurden mehrere Systeme zur interventionellen Rekanalisation bei Lungenembolie etabliert. Wie in anderen Feldern der vaskulären Medizin sind interventionelle Rekanalisationsmethoden auch bei der Lungenembolie potenziell effektiver als die systemische Lysetherapie, unter Umgehung erhöhter Blutungsrisiken. Auch wenn bisher Ergebnisse laufender randomisierter kontrollierter Endpunktstudien noch ausstehen, sind die bisherigen Daten vielversprechend.

Die Rolle des PERT-Teams Die zunehmend komplexere Behandlung der Lungenembolie erfordert spezialisierte interdisziplinäre Behandlungsteams, sog. Pulmonary-Artery-Response-Teams (PERT-Teams) und strukturierte Behandlungsabläufe.

Abstract

Several catheter-based systems have been developed for interventional recanalization of pulmonary embolism. These include local ultrasound assisted thrombolysis (EKOS), in-toto-thrombectomy via retriever and aspiration system (FlowTriever) and the Indigo mechanical aspiration system. Safety and efficacy in the removal of thrombus have been demonstrated for all systems. Interventional recanalization strategies for high- and intermediate-high risk pulmonary embolism are potentially more effective in the removal of thrombus and restoration of right heart function than systemic thrombolysis with a lower risk of major bleeding complications. Preliminary data from registries and observational studies are very promising whereas the evidence for systemic thrombolysis treatment in high and intermediate-high risk pulmonary embolism is low. Randomized controlled clinical trials are currently performed comparing catheter based interventional therapies to systemic thrombolysis for the treatment of intermediate-high risk pulmonary embolisms. Primary outcome measurements include mortality, hemodynamic collapse, and major bleedings. Results are expected in 2025. The introduction of interventional therapies for pulmonary embolism was accompanied by an increased awareness of the complexity of pulmonary embolism management. The need for specialized interdisciplinary pulmonary embolism response teams (PERT-teams) and a well-structured approach including a PDCA cycle was recognized.

Schlüsselwörter

Lungenarterienembolie - Rekanalisation - interventionell - Thrombolyse - PERT-Team - Qualitätsmanagement

Keywords

pulmonary embolism - recanalization - interventional - thrombolysis - PERT-Team - quality management

Publication History

Article published online:
23 May 2024

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