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Int J Angiol
DOI: 10.1055/s-0044-1782535
Review Article

Risks and Benefits of Device-Assisted Treatment of Pulmonary Embolism

Sofia Kim
1   Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
,
Michael Kim
1   Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
,
Arber Kodra
1   Department of Cardiology, Northwell Health Lenox Hill Hospital, New York
› Author Affiliations Funding None.
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Abstract

Pulmonary embolism (PE) is a common disease associated with significant morbidity and mortality. Despite the familiarity with this disease, the best treatment remains undefined. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis, or surgery. However, the debate over pharmacologic versus mechanical treatment of acute PE reared up again with the advent of user-friendly mechanical and aspiration thrombectomy technologies. This is especially true for submassive PE, which is an area for potential growth both for understanding the pathophysiology of the disease process and management. Multiple devices are available for treatment of PE. Understanding the risks and benefits of each device is paramount in the complex management of PE.

Keywords

pulmonary embolism - thrombectomy - catheter-directed thrombolysis - ultrasound - EKOS - Inari


Publication History

Article published online:
26 March 2024

© 2024. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Heit JA. The epidemiology of venous thromboembolism in the community: implications for prevention and management. J Thromb Thrombolysis 2006; 21 (01) 23-29
    CrossrefPubMedGoogle Scholar
  • 2 Saxon RR, Benenati JF, Teigen C, Adams GL, Sewall LE. PRISM Trialists. Utility of a power aspiration–based extraction technique as an initial and secondary approach in the treatment of peripheral arterial thromboembolism: results of the multicenter PRISM trial. J Vasc Interv Radiol 2018; 29 (01) 92-100
    CrossrefPubMedGoogle Scholar
  • 3 Konstantinides SV, Meyer G, Becattini C. et al; ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
    CrossrefPubMedGoogle Scholar
  • 4 Hobohm L, Farmakis IT, Keller K. et al. Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis. Clin Res Cardiol 2023; 112 (10) 1351-1361
    CrossrefPubMedGoogle Scholar
  • 5 Kahn SR, de Wit K. Pulmonary embolism. N Engl J Med 2022; 387 (01) 45-57
    CrossrefPubMedGoogle Scholar
  • 6 Germini F, Zarabi S, Eventov M, Turcotte M, Li M, de Wit K. Pulmonary embolism prevalence among emergency department cohorts: a systematic review and meta-analysis by country of study. J Thromb Haemost 2021; 19 (01) 173-185
    CrossrefPubMedGoogle Scholar
  • 7 Klok FA, Meyer G, Konstantinides S. Management of intermediate-risk pulmonary embolism: uncertainties and challenges. Eur J Haematol 2015; 95 (06) 489-497
    CrossrefPubMedGoogle Scholar
  • 8 Stein PD, Matta F. Thrombolytic therapy in unstable patients with acute pulmonary embolism: saves lives but underused. Am J Med 2012; 125 (05) 465-470
    CrossrefPubMedGoogle Scholar
  • 9 Romano KR, Cory JM, Ronco JJ, Legiehn GM, Bone JN, Finlayson GN. Vancouver general hospital pulmonary embolism response team (VGH PERT): initial three-year experience. Can J Anaesth 2020; 67 (12) 1806-1813
    CrossrefPubMedGoogle Scholar
  • 10 Giri J, Sista AK, Weinberg I. et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 2019; 140 (20) e774-e801
    CrossrefPubMedGoogle Scholar
  • 11 Stevens SM, Woller SC, Baumann Kreuziger L. et al. Executive summary: antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest 2021; 160 (06) 2247-2259
    CrossrefPubMedGoogle Scholar
  • 12 Levine GN, McEvoy JW, Fang JC. et al; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; and Stroke Council. Management of patients at risk for and with left ventricular thrombus: a scientific statement from the American Heart Association. Circulation 2022; 146 (15) e205-e223
    CrossrefPubMedGoogle Scholar
  • 13 Qintar M, Wang DD, Lee J. et al. Transcatheter vacuum-assisted left-sided mass extraction with the AngioVac system. Catheter Cardiovasc Interv 2022; 100 (04) 628-635
    CrossrefPubMedGoogle Scholar
  • 14 Wible BC, Buckley JR, Cho KH, Bunte MC, Saucier NA, Borsa JJ. Safety and efficacy of acute pulmonary embolism treated via large-bore aspiration mechanical thrombectomy using the Inari FlowTriever device. J Vasc Interv Radiol 2019; 30 (09) 1370-1375
    CrossrefPubMedGoogle Scholar
  • 15 Tapson VF, Jimenez D. Catheter-based approaches for the treatment of acute pulmonary embolism. Semin Respir Crit Care Med 2017; 38 (01) 73-83
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Piazza G, Hohlfelder B, Jaff MR. et al; SEATTLE II Investigators. A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. JACC Cardiovasc Interv 2015; 8 (10) 1382-1392
    CrossrefPubMedGoogle Scholar
  • 17 Sadeghipour P, Jenab Y, Moosavi J. et al. Catheter-directed thrombolysis vs anticoagulation in patients with acute intermediate-high–risk pulmonary embolism: the CANARY randomized clinical trial. JAMA Cardiol 2022; 7 (12) 1189-1197
    CrossrefPubMedGoogle Scholar
  • 18 Owens CA. Ultrasound-enhanced thrombolysis: EKOS endowave infusion catheter system. Semin Intervent Radiol 2008; 25 (01) 37-41
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Avgerinos ED, Jaber W, Lacomis J. et al; SUNSET sPE Collaborators. Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE trial. JACC Cardiovasc Interv 2021; 14 (12) 1364-1373 Erratum in: JACC Cardiovasc Interv 2021;14(19):2194
    CrossrefPubMedGoogle Scholar
  • 20 Klok FA, Piazza G, Sharp ASP. et al. Ultrasound-facilitated, catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: rationale and design of the HI-PEITHO study. Am Heart J 2022; 251: 43-53
    CrossrefPubMedGoogle Scholar
  • 21 Silver MJ, Gibson CM, Giri J. et al. Outcomes in high-risk pulmonary embolism patients undergoing FlowTriever mechanical thrombectomy or other contemporary therapies: results from the FLAME study. Circ Cardiovasc Interv 2023; 16 (10) e013406
    CrossrefPubMedGoogle Scholar