title: Usefulness and safety of ultrasound-assisted catheter-directed thrombolysis for submassive pulmonary emboli.
abstract: The optimal treatment for intermediate-risk pulmonary embolism (PE) remains unclear. Our goal was to describe the safety and efficacy of the EkoSonic ultrasound-assisted catheter-directed thrombolysis system (EKOS Corporation, Bothell, Washington) in a real-world registry of patients with intermediate-risk PE. Fifty-three consecutive patients with intermediate-risk PE treated with ultrasound-assisted catheter-directed thrombolysis at Brigham and Women's Hospital from 2010 to 2014 were analyzed. The primary outcome was a change in directly measured pulmonary artery pressures as assessed using logistic regression with generalized estimating equations to account for serial measurements. Patients received an average of 24.6 ± 9 mg of alteplase using the EKOS catheter with an average treatment time of 15.9 ± 3 hours. After treatment, there was a 7.2- and a 11.4-mm Hg reduction in mean and systolic pulmonary artery pressure (95% confidence interval 4.7 to 9.7 mm Hg, p <0.001, and 95% confidence interval 7.8 to 15.0 mm Hg, p <0.001), respectively. In this cohort, 9.4% had any bleeding complication noted during their hospital stay. One patient's alteplase was prematurely discontinued for access site bleeding although no other interventions were required related to bleeding complications.
authors: Division of Cardiology, University of Washington, Seattle, Washington. Electronic address: mccabe@aya.yale.edu.
authors: James M
authors: JM
authors: McCabe
authors: Sutter Heart and Vascular Institute, Sacramento, California.
authors: Pei-Hsiu
authors: PH
authors: Huang
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Lauren
authors: L
authors: Riedl
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Andrew C
authors: AC
authors: Eisenhauer
authors: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Piotr
authors: P
authors: Sobieszczyk
mesh_terms: D000328:Adult; D000368:Aged; D002407:Catheterization, Swan-Ganz; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator