title: Treatment of Massive or Submassive Acute Pulmonary Embolism With Catheter-Directed Thrombolysis.
abstract: The presentation of acute pulmonary thromboembolism (PE) can be highly variable resulting in diagnostic challenges and management difficulties. Current guidelines suggest that therapy must be adjusted based on the severity of PE presentation. Systemic thrombolysis is the standard therapy for acute massive PE; however, systemic thrombolysis carries an estimated 20% risk of major hemorrhage, including a 3% to 5% risk of hemorrhagic stroke. There are data supporting the use of catheter-directed therapy (CDT) in massive and submassive PE, but past studies have limited its use to patients in whom systemic thrombolysis has either failed or was contraindicated. There is a paucity of data comparing the efficacy of CDT compared to systemic thrombolysis in different risk groups. This review will summarize the available data on the techniques and indications and outcomes of CDT for acute PE.
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Mostafa
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Tesfaye
authors.initials: T
authors.lastname: Telila
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Kevin
authors.initials: K
authors.lastname: Belgrave
authors.affiliation: Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan. Electronic address: cgrine@dmc.org.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
mesh_terms: D057785:Catheters; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D017410:Practice Guidelines as Topic; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control; D015912:Thrombolytic Therapy / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D005343:Fibrinolytic Agents