Catheter Thrombolysis for Pulmonary Embolism | Journal Scan

Apr 15, 2015
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Authors:
Kuo WT, Banerjee A, Kim PS, et al.
Citation:
Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): Initial Results From a Prospective Multicenter Registry. Chest 2015;Apr 9:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the safety and effectiveness of catheter-directed therapy (CDT) as an alternative treatment for acute pulmonary embolism (PE)?

Methods:

The investigators enrolled 101 consecutive patients receiving CDT for acute PE in a multicenter registry. Massive PE (n = 28) and submassive PE (n = 73) were treated with immediate catheter-directed mechanical or pharmacomechanical thrombectomy and/or catheter-directed thrombolysis via low-dose hourly drug infusion with tissue plasminogen activator (tPA) or urokinase. Clinical success was defined as meeting all criteria: stabilization of hemodynamics, improvement in pulmonary hypertension and/or right heart strain, and survival to hospital discharge. Primary safety outcomes were major procedure-related complications and major bleeding events.

Results:

There were 53 men and 48 women with average age of 60 years (range, 22-86 years) and mean body mass index of 31.03 ± 7.20 kg/m2. The average thrombolytic doses were 28.0 ± 11 mg tPA (n = 76) and 2,697,101 ± 936,287 IU for urokinase (n = 23). Clinical success was achieved in 24/28 (85.7%) (95% confidence interval [CI], 67.3%-96.0%) patients with massive PE and 71/73 (97.3%) (95% CI, 90.5%-99.7%) with submassive PE. The mean pulmonary artery pressure improved from 51.17 ± 14.06 mm Hg to 37.23 ± 15.81 mm Hg (n = 92; p < 0.0001). Among patients monitored with follow-up echocardiography, 57/64 (89.1%) (95% CI, 78.8%-95.5%; p < 0.0001) showed improvement in right heart strain. There were no major procedure-related complications, no major hemorrhages, and no hemorrhagic strokes.

Conclusions:

The authors concluded that CDT improves clinical outcomes in acute PE patients while minimizing the risk of major bleeding.

Perspective:

This multicenter PE registry reports clinical safety and effectiveness of CDT in a real-world population suffering from acute PE. These data appear to support an optimal CDT protocol of rapid clot debulking for massive PE, while avoiding the AngioJet device to minimize procedure-related complications. Additional prospective randomized studies examining the impact of CDT and low-dose catheter-directed thrombolysis on clinical outcomes of long-term quality of life are indicated.

Keywords: Echocardiography, Stress, Fibrinolytic Agents, Hemodynamics, Hypertension, Pulmonary, Prospective Studies, Pulmonary Artery, Pulmonary Embolism, Quality of Life, Registries, Stroke, Thrombectomy, Tissue Plasminogen Activator, Urokinase-Type Plasminogen Activator


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