Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice
Objectives. We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results. Fourteen patients (eight women and six men; age range: 29–71...
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doaj-6f31a87e3d8347d5a93300285bc81e3c2020-11-25T04:04:39ZengHindawi-WileyJournal of Interventional Cardiology0896-43271540-81832020-01-01202010.1155/2020/41910794191079Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical PracticeAleksander Araszkiewicz0Sylwia Sławek-Szmyt1Stanisław Jankiewicz2Bartosz Żabicki3Marek Grygier4Tatiana Mularek-Kubzdela5Zbigniew Krasiński6Maciej Lesiak71st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, PolandDepartment of Vascular Surgery, Collegium Medicum of Zielona Gora University, 65-417 Zielona Gora, Poland1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, PolandDepartment of Vascular, Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, 61-848 Poznan, Poland1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, PolandObjectives. We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results. Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients’ clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p<0.0001), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p=0.049), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p=0.0051), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p=0.0015), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p<0.0001) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p<0.0001). No major periprocedural bleeding was detected. Conclusions. CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation.http://dx.doi.org/10.1155/2020/4191079 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Aleksander Araszkiewicz Sylwia Sławek-Szmyt Stanisław Jankiewicz Bartosz Żabicki Marek Grygier Tatiana Mularek-Kubzdela Zbigniew Krasiński Maciej Lesiak |
spellingShingle |
Aleksander Araszkiewicz Sylwia Sławek-Szmyt Stanisław Jankiewicz Bartosz Żabicki Marek Grygier Tatiana Mularek-Kubzdela Zbigniew Krasiński Maciej Lesiak Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice Journal of Interventional Cardiology |
author_facet |
Aleksander Araszkiewicz Sylwia Sławek-Szmyt Stanisław Jankiewicz Bartosz Żabicki Marek Grygier Tatiana Mularek-Kubzdela Zbigniew Krasiński Maciej Lesiak |
author_sort |
Aleksander Araszkiewicz |
title |
Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice |
title_short |
Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice |
title_full |
Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice |
title_fullStr |
Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice |
title_full_unstemmed |
Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice |
title_sort |
continuous aspiration thrombectomy in high- and intermediate-high-risk pulmonary embolism in real-world clinical practice |
publisher |
Hindawi-Wiley |
series |
Journal of Interventional Cardiology |
issn |
0896-4327 1540-8183 |
publishDate |
2020-01-01 |
description |
Objectives. We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results. Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients’ clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p<0.0001), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p=0.049), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p=0.0051), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p=0.0015), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p<0.0001) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p<0.0001). No major periprocedural bleeding was detected. Conclusions. CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation. |
url |
http://dx.doi.org/10.1155/2020/4191079 |
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