title: Catheter-Directed Treatment of Pulmonary Embolism: A Systematic Review and Meta-Analysis of Modern Literature.
abstract: We summarize the evidence for the safety and efficacy of catheter-directed thrombolysis (CDT) with and without ultrasound-assisted therapy for treating submassive and massive pulmonary embolism (PE) in a systematic review. The primary efficacy outcome was mortality. Outcomes were pooled across studies with the random-effects model. Twenty-four studies enrolled 700 patients in total; 653 received mechanical thromboembolectomy treatments for PE (mortality rate, 9% [95% confidence interval (CI), 6%-13%], P = .12; rate of minor complications, 6% [95% CI, 2%-13%]). In the ultrasound-accelerated thrombolysis (USAT) studies, the mortality rate was 4% (95% CI, 1%-11%) and in the non-USAT studies, it was 9% (95% CI, 6%-13%). Secondary safety outcomes were all bleeding events, which occurred in 12% (95% CI, 7%-20%) of the USAT studies and in 10% (95% CI, 5%-20%) of the non-USAT studies. Current clinical evidence does not prove USAT is superior over CDT methods.
authors.affiliation: 1 Vascular Medicine, Northshore University HealthSystem, Evanston, IL, USA.
authors.forename: Alfonso J
authors.initials: AJ
authors.lastname: Tafur
authors.affiliation: 2 Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Scottsdale, AZ, USA.
authors.forename: Fadi E
authors.initials: FE
authors.lastname: Shamoun
authors.affiliation: 3 Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Salma I
authors.initials: SI
authors.lastname: Patel
authors.affiliation: 4 Medical Department Buijo Historico 09D23, Ministerio de Salud Publica del Ecuador, Guayaquil, Ecuador.
authors.forename: Denisse
authors.initials: D
authors.lastname: Tafur
authors.affiliation: 5 Oklahoma University Health Science Center, Oklahoma City, OK, USA.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Donna
authors.affiliation: 6 Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D057785:Catheters; D006801:Humans; D011655:Pulmonary Embolism / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods* / Q000401:mortality; D014464:Ultrasonic Therapy / Q000401:mortality
keywords: catheter-directed thrombolysis; pulmonary embolism; thrombolysis