title: Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism.
abstract: OBJECTIVE
  No standardized local thrombolysis regimen exists for the treatment of pulmonary embolism (PE). We retrospectively investigated efficacy and safety of fixed low-dose ultrasound-assisted catheter-directed thrombolysis (USAT) for intermediate- and high-risk PE.
  
  
  RESULTS
  Fifty-two patients (65 ± 14 years) of whom 14 had high-risk PE (troponin positive in all) and 38 intermediate-risk PE (troponin positive in 91%) were treated with intravenous unfractionated heparin and USAT using 10 mg of recombinant tissue plasminogen activator per device over the course of 15 h. Bilateral USAT was performed in 83% of patients. During 3-month follow-up, two [3.8%; 95% confidence interval (CI) 0.5-13%] patients died (one from cardiogenic shock and one from recurrent PE). Major non-fatal bleeding occurred in two (3.8%; 95% CI, 0.5-13%) patients: one intrathoracic bleeding after cardiopulmonary resuscitation requiring transfusion, one intrapulmonary bleeding requiring lobectomy. Mean pulmonary artery pressure decreased from 37 ± 9 mmHg at baseline to 25 ± 8 mmHg at 15 h (P < 0.001) and cardiac index increased from 2.0 ± 0.7 to 2.7 ± 0.9 L/min/m(2) (P < 0.001). Echocardiographic right-to-left ventricular end-diastolic dimension ratio decreased from 1.42 ± 0.21 at baseline to 1.06 ± 0.23 at 24 h (n = 21; P < 0.001). The greatest haemodynamic benefit from USAT was found in patients with high-risk PE and in those with symptom duration < 14 days.
  
  
  CONCLUSIONS
  A standardized catheter intervention approach using fixed low-dose USAT for the treatment of intermediate- and high-risk PE was associated with rapid improvement in haemodynamic parameters and low rates of bleeding complications and mortality.
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Rolf P
authors: RP
authors: Engelberger
authors: Clinic for Cardiology, Swiss Cardiovascular Center, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Aris
authors: A
authors: Moschovitis
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Jennifer
authors: J
authors: Fahrni
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Torsten
authors: T
authors: Willenberg
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Frederic
authors: F
authors: Baumann
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Nicolas
authors: N
authors: Diehm
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Do-Dai
authors: DD
authors: Do
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland.
authors: Iris
authors: I
authors: Baumgartner
authors: Clinic for Angiology, Inselspital-University Hospital and University of Bern, Bern, Switzerland Clinic for Cardiology, Swiss Cardiovascular Center, Inselspital-University Hospital and University of Bern, Bern, Switzerland nils.kucher@insel.ch.
authors: Nils
authors: N
authors: Kucher
mesh_terms: D000368:Aged; D002404:Catheterization / Q000379:methods; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Bleeding; Cardiac output; Catheter-directed thrombolysis; Mortality; Pulmonary artery pressure; Pulmonary embolism