EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism
Background. Percutaneous catheter-based ultrasound-assisted thrombolysis (UACDT) is recommended for patients with intermediate-high-risk or high-risk pulmonary embolism (PE) in whom systemic thrombolysis has failed or is contraindicated. Aim. To evaluate the safety and efficiency of UACDT in patient...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Canadian Respiratory Journal |
| Online Access: | http://dx.doi.org/10.1155/2022/7135958 |
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| author | Friederike Klein Sven Möbius-Winkler Laura Bäz Rüdiger Pfeifer Michael Fritzenwanger Stefan Heymel Marcus Franz Pawel Aftanski P. Christian Schulze Daniel Kretzschmar |
| author_facet | Friederike Klein Sven Möbius-Winkler Laura Bäz Rüdiger Pfeifer Michael Fritzenwanger Stefan Heymel Marcus Franz Pawel Aftanski P. Christian Schulze Daniel Kretzschmar |
| author_sort | Friederike Klein |
| collection | DOAJ |
| description | Background. Percutaneous catheter-based ultrasound-assisted thrombolysis (UACDT) is recommended for patients with intermediate-high-risk or high-risk pulmonary embolism (PE) in whom systemic thrombolysis has failed or is contraindicated. Aim. To evaluate the safety and efficiency of UACDT in patients with intermediate-high-risk or high-risk PE. Methods. Between October 2017 and January 2020, we performed UACDT using the EkoSonic™ Endovascular System (EKOS™) in 51 patients (21 males, age 63 ± 18 years) with a sPESI of 1.3 ± 0.7. The EKOS™-catheter was implanted within 24 h after admission. Over 15 hours, 11.5 mg of alteplase was administered per catheter. We evaluated right ventricular stress and cardiac biomarkers before and after UACDT. Results. 24 h post-UACDT, median RV/LV ratio decreased from 1.13 to 0.96 (p<0.001) and the mean sPAP decreased from 47 ± 3 to 32 ± 2 mmHg + CVP (p<0.0002). There were 6 major bleeding events resulting in transfusion. No stroke, myocardial infarction, right heart decompensation, or recurrent PE occurred. 31 patients (63%) were discharged without any signs of right ventricular stress. After at least 3 months, 73% of our patients did not show any signs of right ventricular dysfunction. The mean RV/LV ratio decreased to 0.75 ± 0.03 (p<0.0001) in comparison with pre-UACDT, sPAP to 23 mmHg + CVP (p<0.0001), and BNP to 40 pg/ml (p<0.0001). Conclusions. The treatment with UACDT reduced right heart stress during the first 24 hours and midterm in patients with intermediate-high-risk or high-risk PE at an acceptable rate of severe complications. |
| format | Article |
| id | doaj-art-0f158b29525345e4959fc04095f644e7 |
| institution | Kabale University |
| issn | 1916-7245 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Respiratory Journal |
| spelling | doaj-art-0f158b29525345e4959fc04095f644e72025-02-03T01:20:11ZengWileyCanadian Respiratory Journal1916-72452022-01-01202210.1155/2022/7135958EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary EmbolismFriederike Klein0Sven Möbius-Winkler1Laura Bäz2Rüdiger Pfeifer3Michael Fritzenwanger4Stefan Heymel5Marcus Franz6Pawel Aftanski7P. Christian Schulze8Daniel Kretzschmar9Department of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IDepartment of Internal Medicine IBackground. Percutaneous catheter-based ultrasound-assisted thrombolysis (UACDT) is recommended for patients with intermediate-high-risk or high-risk pulmonary embolism (PE) in whom systemic thrombolysis has failed or is contraindicated. Aim. To evaluate the safety and efficiency of UACDT in patients with intermediate-high-risk or high-risk PE. Methods. Between October 2017 and January 2020, we performed UACDT using the EkoSonic™ Endovascular System (EKOS™) in 51 patients (21 males, age 63 ± 18 years) with a sPESI of 1.3 ± 0.7. The EKOS™-catheter was implanted within 24 h after admission. Over 15 hours, 11.5 mg of alteplase was administered per catheter. We evaluated right ventricular stress and cardiac biomarkers before and after UACDT. Results. 24 h post-UACDT, median RV/LV ratio decreased from 1.13 to 0.96 (p<0.001) and the mean sPAP decreased from 47 ± 3 to 32 ± 2 mmHg + CVP (p<0.0002). There were 6 major bleeding events resulting in transfusion. No stroke, myocardial infarction, right heart decompensation, or recurrent PE occurred. 31 patients (63%) were discharged without any signs of right ventricular stress. After at least 3 months, 73% of our patients did not show any signs of right ventricular dysfunction. The mean RV/LV ratio decreased to 0.75 ± 0.03 (p<0.0001) in comparison with pre-UACDT, sPAP to 23 mmHg + CVP (p<0.0001), and BNP to 40 pg/ml (p<0.0001). Conclusions. The treatment with UACDT reduced right heart stress during the first 24 hours and midterm in patients with intermediate-high-risk or high-risk PE at an acceptable rate of severe complications.http://dx.doi.org/10.1155/2022/7135958 |
| spellingShingle | Friederike Klein Sven Möbius-Winkler Laura Bäz Rüdiger Pfeifer Michael Fritzenwanger Stefan Heymel Marcus Franz Pawel Aftanski P. Christian Schulze Daniel Kretzschmar EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism Canadian Respiratory Journal |
| title | EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism |
| title_full | EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism |
| title_fullStr | EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism |
| title_full_unstemmed | EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism |
| title_short | EKOS™ Jena Experience: Safety, Feasibility, and Midterm Outcomes of Percutaneous Ultrasound-Assisted Catheter-Directed Thrombolysis in Patients with Intermediate-High-Risk or High-Risk Pulmonary Embolism |
| title_sort | ekos™ jena experience safety feasibility and midterm outcomes of percutaneous ultrasound assisted catheter directed thrombolysis in patients with intermediate high risk or high risk pulmonary embolism |
| url | http://dx.doi.org/10.1155/2022/7135958 |
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