Aspiration thrombectomy for acute pulmonary embolism with an intermediate-high risk

被引:4
作者
Romeu-Prieto, Juan Maria [1 ]
Sanchez Casado, Marcelino [1 ]
Rodriguez Blanco, Maria Luisa [1 ]
Ciampi-Dopazo, Juan Jose [2 ]
Sanchez-Carretero, Maria Jose [1 ]
Garcia-Lopez, Jose Javier [3 ]
Lanciego-Perez, Carlos [2 ]
机构
[1] Hosp Virgen de la Salud, Serv Med Intens, Toledo, Spain
[2] Hosp Virgen de la Salud, Unidad Radiol Intervencionista, Toledo, Spain
[3] Hosp Gen Univ Gregorio Maranon, Serv Neumol, Madrid, Spain
来源
MEDICINA CLINICA | 2022年 / 158卷 / 09期
关键词
Pulmonary embolism; Thrombectomy; Fibrinolysis; Echocardiography; PaFi; TAPSE; MECHANICAL THROMBECTOMY; THROMBOLYTIC TREATMENT; MULTICENTER TRIAL; SINGLE-ARM; FIBRINOLYSIS; METAANALYSIS; MANAGEMENT; THROMBOSIS;
D O I
10.1016/j.medcli.2021.04.033
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction and purpose: The treatment of acute pulmonary embolism (PE) with an intermediate-high risk of mortality at 30 days is still not well defined, recommending the latest clinical guidelines of the European Society of Cardiology 2019 exclusively anticoagulant treatment, reducing the indication for mechanical thrombectomy to high-risk patients or intermediate-high risk patients with poor hemodynamic evolution. Our purpose is to determine the safety and efficacy of aspiration thrombectomy in intermediate-high risk patients with PE and to analyze possible differences in these results between hemodynamically unstable patients (massive PE) and hemodynamically stable patients (submassive PE). Methods: We analyzed all patients who underwent aspiration thrombectomy for PE at our tertiary university hospital during a 34-month period. We compared echocardiographic parameters (right ventricular diameter, tricuspid plane annular plane systolic excursion (TAPSE), S' wave, and pulmonary hypertension), respiratory parameters (PaO2/FiO(2) ratio), and clinical parameters recorded before and 24h after the procedure. We also analyzed bleeding complications and mortality. Results: In the 42 patients included (16 with massive PE and 26 with submas sive PE), aspiration thrombectomy resulted in significant improvements in right ventricular diameter, TAPSE, S' wave, andPaO(2)/FiO(2) ratio. Of the 8 patients administered fibrinolysis, 4 developed bleeding complications. Only one direct complication of the procedure was observed (pulmonary artery rupture). Eight patients died in the acute phase. Conclusions: Aspiration thrombectomy for PE is safe and effective, significantly improving respiratory and hemodynamic parameters in the first 24 h after the procedure with a low rate of complications compared to fibrinolysis. (C) 2021 Elsevier Espana, S.L.U. All rights reserved.
引用
收藏
页码:401 / 405
页数:5
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