title: Safety of catheter-directed thrombolysis for massive and submassive pulmonary embolism: Results of a multicenter registry and meta-analysis.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) in the treatment of acute pulmonary embolism (PE).
  
  
  BACKGROUND
  The use of CDT for the treatment of acute submassive and massive PE is increasing in frequency. However, its safety and efficacy have not been well elucidated.
  
  
  METHODS
  This study is made of two parts: one is a two-center registry of acute PE patients treated with CDT. The safety outcome evaluated was any major complication including fatal, intracranial (ICH), intraocular, or retroperitoneal hemorrhage or any overt bleeding requiring transfusion or surgical repair. The efficacy outcome was acute change in invasive pulmonary artery systolic pressure (PASP). The second part is a meta-analysis of all contemporary studies that used CDT for PE. Reported outcomes are the same as in the registry, with the addition of right ventricular to left ventricular (RV/LV) ratio change.
  
  
  RESULTS
  In the registry, 137 patients were included (age 59 ± 15, 50% male, 88% submassive PE). ICH occurred in two patients and major complications in 13 (9.4%). PASP decreased post procedure by 19 ± 15 mm Hg (95% CI 16-23). In the meta-analysis, 16 studies were included with 860 patients. Rate of ICH was 0.35% and the major complication rate was 4.65%, most requiring transfusion only. In-hospital mortality was 12.9% in the massive and 0.74% in the submassive group. All studies showed improvement in PASP and/or RV/LV ratio post CDT.
  
  
  CONCLUSIONS
  CDT is associated with a low major complication rate. Randomized studies are needed to evaluate its efficacy relative to anticoagulation alone. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Tyler L
authors.initials: TL
authors.lastname: Bloomer
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Georges E
authors.initials: GE
authors.lastname: El-Hayek
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: McDaniel
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Breck C
authors.initials: BC
authors.lastname: Sandvall
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Liberman
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Chandan M
authors.initials: CM
authors.lastname: Devireddy
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Gautam
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Pete P
authors.initials: PP
authors.lastname: Fong
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Wissam A
authors.initials: WA
authors.lastname: Jaber
mesh_terms: D000208:Acute Disease; D000792:Angiography; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D062905:Central Venous Catheters; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015337:Multicenter Studies as Topic; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy*; D012042:Registries; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents
keywords: catheter-directed thrombolysis; meta-analysis; pulmonary embolism