Abstract
Purpose: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. Materials and Methods: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score. Results: Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO2), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence. Conclusion: The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.
| Original language | English |
|---|---|
| Pages (from-to) | 1840-1848 |
| Number of pages | 9 |
| Journal | CardioVascular and Interventional Radiology |
| Volume | 41 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
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Keywords
- Catheter-directed treatment (CDT)
- Computed tomography angiography (CTA)
- Massive pulmonary embolism
- Pulmonary embolism (PE)
- Submassive pulmonary embolism
- Thrombolysis
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cardiology and Cardiovascular Medicine
Cite this
Acute Massive and Submassive Pulmonary Embolism : Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis. / Pieraccini, Massimo; Guerrini, Susanna; Laiolo, Edoardo; Puliti, Alessio; Roviello, Giandomenico; Misuraca, Leonardo; Spargi, Genni; Limbruno, Ugo; Breggia, Mauro; Grechi, Morando.
In: CardioVascular and Interventional Radiology, Vol. 41, No. 12, 01.12.2018, p. 1840-1848.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Acute Massive and Submassive Pulmonary Embolism
T2 - Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis
AU - Pieraccini, Massimo
AU - Guerrini, Susanna
AU - Laiolo, Edoardo
AU - Puliti, Alessio
AU - Roviello, Giandomenico
AU - Misuraca, Leonardo
AU - Spargi, Genni
AU - Limbruno, Ugo
AU - Breggia, Mauro
AU - Grechi, Morando
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Purpose: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. Materials and Methods: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score. Results: Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO2), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence. Conclusion: The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.
AB - Purpose: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. Materials and Methods: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score. Results: Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO2), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence. Conclusion: The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.
KW - Catheter-directed treatment (CDT)
KW - Computed tomography angiography (CTA)
KW - Massive pulmonary embolism
KW - Pulmonary embolism (PE)
KW - Submassive pulmonary embolism
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=85049583680&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85049583680&partnerID=8YFLogxK
U2 - 10.1007/s00270-018-2011-3
DO - 10.1007/s00270-018-2011-3
M3 - Article
C2 - 29980817
AN - SCOPUS:85049583680
VL - 41
SP - 1840
EP - 1848
JO - CardioVascular and Interventional Radiology
JF - CardioVascular and Interventional Radiology
SN - 7415-5101
IS - 12
ER -