title: Intracranial hemorrhage in a patient with sub-massive pulmonary embolism treated with EkoSonic endovascular system directed thrombolysis.
abstract: Ultrasound-assisted catheter-directed thrombolysis therapy has emerged more recently as a management strategy for patients with intermediate risk pulmonary embolism and has shown promising results in clinical trials by early reversal of right ventricle dilation, reduced pulmonary hypertension, and decreased anatomic thrombus burden. This therapeutic strategy requires a small fraction of the systemic fibrinolytic dose and is therefore associated with a reduced bleeding risk. Although intracranial hemorrhage has not been reported in clinical trials, it is a possible complication. Here we report the first case of intracranial hemorrhage related to the use of EkoSonic™ Endovascular System directed thrombolysis in a patient with large bilateral pulmonary embolism without any identifiable bleeding risks. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Sarju
authors.identifier: http://orcid.org/0000-0003-0296-6864
authors.initials: S
authors.lastname: Ganatra
authors.affiliation: Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Arjun
authors.initials: A
authors.lastname: Majithia
authors.affiliation: Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Yun-Ting Eric
authors.initials: YE
authors.lastname: Yeh
authors.affiliation: Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Levy
mesh_terms: D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography; D004452:Echocardiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000378:metabolism*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D062666:Vascular Access Devices
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: EKOS; EkoSonic endovascular system; intracranial hemorrhage; pulmonary embolism; ultrasound-assisted catheter-directed thrombolysis