title: Ultrasound-Assisted Catheter-Directed Thrombolysis in High-Risk and Intermediate-High-Risk Pulmonary Embolism: A Meta-Analysis.
abstract: Catheter-directed Ultrasound-Assisted Thrombolysis (USAT) is a novel technology providing a high efficacy with a reduced bleeding risk in patients with pulmonary embolism (PE).
  
  
  
  We performed a meta-analysis based on presented or published PE series in which USAT was utilized. We searched the MEDLINE, EMBASE and the Cochrane Library for trials published up to December 2015.
  
  
  
  The primary outcomes were mean pulmonary artery pressure (PAMP), right to left ventricle diameter ratio (RV/LV ratio) and computed tomography (CT) obstruction score. The secondary outcomes were all-cause and cardiovascular mortality, major and minor bleeding episodes and recurrent PE. The 11 trials (n=553) and 15 trials (n=655) met eligibility criteria of primary and secondary outcomes, respectively. USAT was found to significantly reduce PAMP, RV/LV ratio and CT obstruction scores. After adjusting for baseline covariates in meta-regression analysis, male sex and number of high-risk patients were found to be associated with PAMP and RV/LV ratio while only male sex was associated with CT obstruction scores. The pooled incidence of all-cause and cardiovascular mortality were 3.2% and 2.2%, and the incidence of major and minor bleeding episodes were 5.5% and 6.9%, respectively. In the pooled analysis of the remaining trials, the incidence of recurrent PE was 1.7%. USAT compared with three randomized thrombolytic trials showed a similar death rate with a lower rate of major bleeding.
  
  
  
  This meta-analysis confirmed that USAT significantly reduced PAMP, RV/LV ratio and CT obstruction scores with similar death rates and a lower risk of major bleeding compared with patients with PE undergoing systemic thrombolytic treatment.
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Cihangir
authors.initials: C
authors.lastname: Kaymaz
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Ozgur Yasar
authors.initials: OY
authors.lastname: Akbal
authors.affiliation: Department of Cardiology, Ataturk University, Medical School, Erzurum, Turkey.|Department of Biostatistics, Ataturk University, Medical School, Erzurum, Turkey.
authors.forename: Ibrahim Halil
authors.initials: IH
authors.lastname: Tanboga
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Aykun
authors.initials: A
authors.lastname: Hakgor
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Yilmaz
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Selcuk
authors.initials: S
authors.lastname: Ozturk
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Nertila
authors.initials: N
authors.lastname: Poci
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Sevim
authors.initials: S
authors.lastname: Turkday
authors.affiliation: Department of Cardiology, Unıversity of Health Sciences, Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
authors.forename: Nihal
authors.initials: N
authors.lastname: Ozdemir
authors.affiliation: Department of Cardiology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.|Centre for Thrombosis and Hemostasis, University Medical Centre Mainz, Johannes Gutenberg, University of Mainz, Mainz, Germany.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure / Q000187:drug effects; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000401:mortality
chemical_list: D005343:Fibrinolytic Agents
keywords: EkoSonic® endovascular system; catheter-directed thrombolysis; metaanalysis; pulmonary embolism; thrombolytics; ultrasound-assisted thrombolysis