Neue Techniken in der Behandlung der Lungenembolie – wann interventionell und wie?

Bei einer LE mit hohem Mortalitätsrisiko empfiehlt die ESC-Leitlinie eine systemische Thrombolyse. Interventionelle Techniken werden jedoch immer sicherer in der Anwendung und effektiver in der unmittelbaren Senkung der rechtsventrikulären Nachlast.

Publication History

Article published online:
27 February 2025

• Literatur

• 1 Raskob GE, Angchaisuksiri P, Blanco AN. et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014; 34: 2363-2371
• 2 Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res 2016; 118: 1340-1347
• 3 Jiménez D, de Miguel-Díez J, Guijarro R. et al. Trends in the Management and Outcomes of Acute Pulmonary Embolism: Analysis From the RIETE Registry. J Am Coll Cardiol 2016; 67: 162-170
• 4 Keller K, Hobohm L, Ebner M. et al. Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J 2020; 41: 522-529
• 5 Pugliese SC, Kawut SM. The Post-Pulmonary Embolism Syndrome: Real or Ruse?. Ann Am Thorac Soc 2019; 16: 811-814
• 6 Jansa P, Ambroz D, Aschermann M. et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG). Cor Et Vasa 2023; 65: 236-286
• 7 McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol 1971; 28: 288-294
• 8 Smulders YM. Pathophysiology and treatment of haemodynamic instability in acute pulmonary embolism: the pivotal role of pulmonary vasoconstriction. Cardiovasc Res 2000; 48: 23-33
• 9 Konstantinides SV, Meyer G, Becattini C. et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41: 543-603
• 10 Kobayashi T, Pugliese S, Sethi SS. et al. Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism. J Am Coll Cardiol 2024; 83: 35-43
• 11 Verstraete M, Miller GAH, Bounameaux H. et al. Intravenous and Intrapulmonary Recombinant Tissue-Type Plasminogen-Activator in the Treatment of Acute Massive Pulmonary-Embolism. Circulation 1988; 77: 353-360
• 12 Schmitz-Rode T, Kilbinger M, Gunther RW. Simulated flow pattern in massive pulmonary embolism: Significance for selective intrapulmonary thrombolysis. Cardiovasc Intervent Radiol 1998; 21: 199-204
• 13 Francis CW, Blinc A, Lee S. et al. Ultrasound Accelerates Transport of Recombinant Tissue-Plasminogen Activator into Clots. Ultrasound Med Biol 1995; 21: 419-424
• 14 [Anonym]. Low Dose Thrombolysis, Ultrasound Assisted Thrombolysis or Heparin for Intermediate High Risk Pulmonary Embolism (STRATIFY). 2024 Accessed January 16, 2025 at: https://clinicaltrials.gov/study/NCT04088292
• 15 Avgerinos ED, Jaber W, Lacomis J. et al. Randomized Trial Comparing Standard Versus Ultrasound-Assisted Thrombolysis for Submassive Pulmonary Embolism: The SUNSET sPE Trial. JACC Cardiovasc Interv 2021; 14: 1364-1373
• 16 Lin JL, Chen IY, Yang PK. Comparison of the Clinical Efficacy and Safety of Standard and Ultrasound-Assisted Thrombolysis for Pulmonary Embolism: A Systematic Review and Meta-Analysis. J Endovasc Ther 2023;
• 17 Planer D, Yanko S, Matok I. et al. Catheter-directed thrombolysis compared with systemic thrombolysis and anticoagulation in patients with intermediate- or high-risk pulmonary embolism: systematic review and network meta-analysis. CMAJ 2023; 195: E833-E843
• 18 Zhang RS, Maqsood MH, Sharp ASP. et al. Efficacy and Safety of Anticoagulation, Catheter-Directed Thrombolysis, or Systemic Thrombolysis in Acute Pulmonary Embolism. JACC Cardiovasc Interv 2023; 16: 2644-2651
• 19 [Anonym]. Evaluating the Safety and Efficacy of the AlphaVac Multipurpose Mechanical Aspiration (MMA) F1885 PE for Treatment of Acute Pulmonary Embolism (APEX-AV). 2024 Accessed January 16, 2025 at: https://clinicaltrials.gov/study/NCT05318092
• 20 Toma C, Jaber WA, Weinberg MD. et al. Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism. EuroIntervention 2023; 18: 1201-1212
• 21 Tu T, Toma C, Tapson VF. et al. A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism: The FLARE Study. JACC Cardiovasc Interv 2019; 12: 859-869
• 22 Silver MJ, Gibson CM, Giri J. et al. Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy or Other Contemporary Therapies: Results From the FLAME Study. Circ Cardiovasc Interv 2023; 16: e013406
• 23 Sista AK, Horowitz JM, Tapson VF. et al. Indigo Aspiration System for Treatment of Pulmonary Embolism Results of the EXTRACT-PE Trial. JACC Cardiovasc Interv 2021; 14: 319-329
• 24 Moriarty JM, Dohad SY, Schiro BJ. et al. Clinical, Functional, and Quality-of-Life Outcomes after Computer Assisted Vacuum Thrombectomy for Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study. J Vasc Interv Radiol 2024; 35: 1154-1165
• 25 [Anonym]. The PEERLESS Study. 2022–2024. Accessed January 16, 2025 at: https://classic.clinicaltrials.gov/ct2/show/NCT05111613
• 26 [Anonym]. The PEERLESS 2 study. 2023–2026. Accessed January 16, 2025 at: https://clinicaltrials.gov/study/NCT06055920
• 27 [Anonym]. The PERSEVERE study. 2022–2029. Accessed January 16, 2025 at: https://clinicaltrials.gov/study/NCT05174767
• 28 [Anonym]. STORM-PE: A Prospective, Multicenter, Randomized Controlled Trial Evaluating Anticoagulation Alone vs Anticoagulation Plus Mechanical Aspiration With the Indigo® Aspiration System for the Treatment of Intermediate High Risk Acute Pulmonary Embolism. 2023–2026. Accessed February 20, 2025 at: https://clinicaltrials.gov/study/NCT05684796
• 29 [Anonym]. Catheter-directed Thrombectomy in High and Intermediate-high Risk Pulmonary Embolism (CATH-PE). 2018–2022. Accessed January 16, 2025 at: https://clinicaltrials.gov/study/NCT04473560
• 30 Jaber WA, Gonsalves CF, Stortecky S. et al. Large-bore Mechanical Thrombectomy Versus Catheter-directed Thrombolysis in the Management of Intermediate-risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial. Circulation 2024;
• 31 Pruszczyk P, Klok FA, Kucher N. et al. Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention 2022; 18: e623-e638
• 32 Le Gal G, Righini M, Roy PM. et al. Prediction of pulmonary embolism in the emergency department: The revised Geneva score. Ann Intern Med 2006; 144: 165-171
• 33 Parikh M, Chahine NM, Hammad TA. et al. Predictors and potential advantages of PERT and advanced therapy use in acute pulmonary embolism. Catheter Cardiovasc Interv 2021; 97: 1430-1437
• 34 Rosovsky R, Chang YC, Rosenfield K. et al. Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis 2019; 47: 31-40
• 35 Kucher N, Boekstegers P, Muller OJ. et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 2014; 129: 479-486
• 36 Rawal A, Ardeshna D, Hesterberg K. et al. Is there an optimal “door to cath time” in the treatment of acute pulmonary embolism with catheter-directed thrombolysis?. Ann Transl Med 2019; 7: 419