Ultrasound-Assisted Catheter-Directed Thrombolysis: A Novel and Promising Endovascular Therapeutic Modality for Intermediate-Risk Pulmonary Embolism.
Intermediate-risk pulmonary embolism (PE), also known as submassive PE, occurs in a substantial group of patients and carries a significant mortality risk. With adequate risk stratification, catheter-directed techniques could be used as a therapeutic approach in the intermediate-risk PE. Ultrasound-assisted catheter-directed thrombolysis (UCDT) represents a novel endovascular technique with good clinical and safety outcomes. Ultrasound-assisted catheter-directed thrombolysis can achieve reduction in the thrombus burden and improvement of pulmonary hemodynamics and right ventricular (RV) dysfunction and/or dilatation, without major procedure-related complications, major bleeding, or hemorrhagic strokes. This narrative review will focus on the major studies involving the efficacy and safety of UCDT in the intermediate-risk PE population. Prospective, randomized clinical trials with long-term follow-up and a large sample size are needed for further evaluation of mortality benefit and to further define which subgroup of patients may benefit from this novel endovascular technique.
1 Department of General Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.|2 Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Mohamed
M
Teleb
1 Department of General Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Mateo
M
Porres-Aguilar
3 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Belinda
B
Rivera-Lebron
1 Department of General Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Kyari Sumayin
KS
Ngamdu
1 Department of General Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Gehan
G
Botrus
4 Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutricion "Salvador Zubirán, México City, México.
Javier E
JE
Anaya-Ayala
2 Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Debabrata
D
Mukherjee
D002406:Catheterization, Peripheral; D057510:Endovascular Procedures / Q000379:methods*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D011655:Pulmonary Embolism / Q000188:drug therapy*; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods*; D018084:Ultrasonography, Interventional
D005343:Fibrinolytic Agents
intermediate-risk pulmonary embolism; submassive pulmonary embolism; thrombolytics; ultrasound-assisted catheter-directed thrombolysis