title: Catheter-Directed Therapy in Acute Pulmonary Embolism with Right Ventricular Dysfunction: A Promising Modality to Provide Early Hemodynamic Recovery.
abstract: BACKGROUND Catheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure. MATERIAL AND METHODS Medical records of consecutive patients diagnosed as having acute massive or submassive PE with accompanying RVD treated by immediate CDT at our institution from January 2007 to January 2014 were reviewed. Patient characteristics, mortality, achievement of clinical success, and minor and major bleeding complications were analyzed in the overall study group, as well as massive vs. submassive PE subgroups. Change in hemodynamic parameters in the second, eighth, and 24th hours after the CDT procedure were also analyzed. RESULTS The study included 15 consecutive patients (M/F=10/5) with a mean age of 54.2 ± 16.6 years who underwent immediate CDT. Nine of the patients had submassive PE, and 6 had massive PE. In-hospital mortality rate was 13.3% (95% CI, 0.04-0.38). One major, but not life-threatening, bleeding episode was evident in the whole group. Hemodynamic parameters were stabilized and clinical success was achieved in 14/15 (93.3%; 95% CI, 70.2-98.8) of the patients in the first 24 hours. Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure. CONCLUSIONS CDT is a promising treatment option for patients with acute PE with RVD with no fatal bleeding complication. In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.
authors.affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Asli Gorek
authors.initials: AG
authors.lastname: Dilektasli
authors.affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Ezgi
authors.initials: E
authors.lastname: Demirdogen Cetinoglu
authors.affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Nilufer Aylin
authors.initials: NA
authors.lastname: Acet
authors.affiliation: Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Erdogan
authors.affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ursavas
authors.affiliation: Department of Biostatistics, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Guven
authors.initials: G
authors.lastname: Ozkaya
authors.affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Funda
authors.initials: F
authors.lastname: Coskun
authors.affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Karadag
authors.affiliation: Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.
authors.forename: Ercument
authors.initials: E
authors.lastname: Ege
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000628:therapy