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Semin intervent Radiol 2020; 37(01): 062-073
DOI: 10.1055/s-0039-3401841
DOI: 10.1055/s-0039-3401841
Review Article
Role of Interventional Radiologist in the Management of Acute Pulmonary Embolism
Further Information
Publication History
Publication Date:
04 March 2020 (online)
Abstract
Pulmonary embolism is a common cause of morbidity and mortality which continues to increase in overall incidence. Because it can occur with a wide range of clinical presentations, different guidelines have been developed for appropriate risk stratification of patients; interventional radiology plays a vital role in the management of both massive and submassive pulmonary embolism. Catheter-directed therapy, including mechanical and aspiration thrombectomy, standard catheter-directed thrombolysis, and ultrasound-accelerated thrombolysis, has many benefits, including lower thrombolytic doses and intraclot administration of thrombolytic therapy. While the role of catheter-directed therapy is still being developed, four important prospective studies have demonstrated its safety and efficacy. Additional studies comparing short- and long-term clinical outcomes in patients treated with catheter-directed therapy versus anticoagulation are the next step in understanding its role within the management of submassive pulmonary embolism. Furthermore, multidisciplinary pulmonary embolism response teams, in which interventional radiology plays a crucial role, are becoming essential to appropriately managing pulmonary embolism patients, including selection of those who may benefit from catheter-directed therapy.
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References
- 1 The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Rockville, MD: 2008
- 2 Smith SB, Geske JB, Kathuria P. , et al. Analysis of national trends in admissions for pulmonary embolism. Chest 2016; 150 (01) 35-45
- 3 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353 (9162): 1386-1389
- 4 Rybstein MD, DeSancho MT. Hypercoagulable states and thrombophilias: risks relating to recurrent venous thromboembolism. Semin Intervent Radiol 2018; 35 (02) 99-104
- 5 Turetz M, Sideris AT, Friedman OA, Triphathi N, Horowitz JM. Epidemiology, pathophysiology, and natural history of pulmonary embolism. Semin Intervent Radiol 2018; 35 (02) 92-98
- 6 Hirsch DR, Ingenito EP, Goldhaber SZ. Prevalence of deep venous thrombosis among patients in medical intensive care. JAMA 1995; 274 (04) 335-337
- 7 Harrison's Principles of Internal Medicine. New York, NY: MacGraw Hill Education; 2012. 2: 2170-2171
- 8 McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol 1971; 28 (03) 288-294
- 9 Piazza G, Goldhaber SZ. The acutely decompensated right ventricle: pathways for diagnosis and management. Chest 2005; 128 (03) 1836-1852
- 10 Piazza G, Goldhaber SZ. Fibrinolysis for acute pulmonary embolism. Vasc Med 2010; 15 (05) 419-428
- 11 Egermayer P, Peacock AJ. Is pulmonary embolism a common cause of chronic pulmonary hypertension? Limitations of the embolic hypothesis. Eur Respir J 2000; 15 (03) 440-448
- 12 Kuo WT, Sista AK, Faintuch S. , et al. Society of interventional radiology position statement on catheter-directed therapy for acute pulmonary embolism. J Vasc Interv Radiol 2018; 29 (03) 293-297
- 13 Jaff MR, McMurtry MS, Archer SL. , et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; American Heart Association Council on Peripheral Vascular Disease; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123 (16) 1788-1830
- 14 Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation 2006; 113 (04) 577-582
- 15 Meyer G, Vicaut E, Danays T. , et al; PEITHO Investigators. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014; 370 (15) 1402-1411
- 16 Kang DK, Thilo C, Schoepf UJ. , et al. CT signs of right ventricular dysfunction: prognostic role in acute pulmonary embolism. JACC Cardiovasc Imaging 2011; 4 (08) 841-849
- 17 Subramaniam RM, Mandrekar J, Chang C. , et al. Pulmonary embolism outcome: a prospective evaluation of CT pulmonary angiographic clot burden score and ECG score. AJR Am J Roentgenol 2008; 190 (06) 1599-1604
- 18 Chiarello MA, Sista AK. Catheter-directed thrombolysis for submassive pulmonary embolism. Semin Intervent Radiol 2018; 35 (02) 122-128
- 19 Konstantinides SV. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35 (45) 3145-3146
- 20 Mercat A, Diehl JL, Meyer G, Teboul JL, Sors H. Hemodynamic effects of fluid loading in acute massive pulmonary embolism. Crit Care Med 1999; 27 (03) 540-544
- 21 Ghignone M, Girling L, Prewitt RM. Volume expansion versus norepinephrine in treatment of a low cardiac output complicating an acute increase in right ventricular afterload in dogs. Anesthesiology 1984; 60 (02) 132-135
- 22 Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of pulmonary embolism: an update. J Am Coll Cardiol 2016; 67 (08) 976-990
- 23 Moriarty JM, Edwards M, Plotnik AN. Intervention in massive pulmonary embolus: catheter thrombectomy/thromboaspiration versus systemic lysis versus surgical thrombectomy. Semin Intervent Radiol 2018; 35 (02) 108-115
- 24 Chatterjee S, Chakraborty A, Weinberg I. , et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA 2014; 311 (23) 2414-2421
- 25 Marti C, John G, Konstantinides S. , et al. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2015; 36 (10) 605-614
- 26 Kline JA, Nordenholz KE, Courtney DM. , et al. Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial. J Thromb Haemost 2014; 12 (04) 459-468
- 27 Almoosa K. Is thrombolytic therapy effective for pulmonary embolism?. Am Fam Physician 2002; 65 (06) 1097-1102
- 28 Sista AK. Pulmonary embolism: the astute interventional radiology clinician. Semin Intervent Radiol 2017; 34 (01) 11-15
- 29 Konstantinides SV, Vicaut E, Danays T. , et al. Impact of thrombolytic therapy on the long-term outcome of intermediate-risk pulmonary embolism. J Am Coll Cardiol 2017; 69 (12) 1536-1544
- 30 Konstantinides SV, Torbicki A, Agnelli G. , et al; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35 (43) 3033-3069 , 3069a–3069k
- 31 Kuo WT, Gould MK, Louie JD, Rosenberg JK, Sze DY, Hofmann LV. Catheter-directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques. J Vasc Interv Radiol 2009; 20 (11) 1431-1440
- 32 Kuo WT. Endovascular therapy for acute pulmonary embolism. J Vasc Interv Radiol 2012; 23 (02) 167-79.e4 , quiz 179
- 33 Jolly M, Phillips J. Pulmonary embolism: current role of catheter treatment options and operative thrombectomy. Surg Clin North Am 2018; 98 (02) 279-292
- 34 Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W. ; Management Strategies and Prognosis of Pulmonary Embolism-3 Trial Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002; 347 (15) 1143-1150
- 35 Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M. ; “MOPETT” Investigators. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol 2013; 111 (02) 273-277
- 36 Schmitz-Rode T, Kilbinger M, Günther RW. Simulated flow pattern in massive pulmonary embolism: significance for selective intrapulmonary thrombolysis. Cardiovasc Intervent Radiol 1998; 21 (03) 199-204
- 37 Devcic Z, Kuo WT. Percutaneous pulmonary embolism thrombectomy and thrombolysis: technical tips and tricks. Semin Intervent Radiol 2018; 35 (02) 129-135
- 38 Kandarpa K, Machan L, Durham J. Handbook of Interventional Radiologic Procedures. Philadelphia, PA: Lippincott Willliams & Wilkins; 2016: 347
- 39 Uflacker R. Interventional therapy for pulmonary embolism. J Vasc Interv Radiol 2001; 12 (02) 147-164
- 40 Owens CA. Ultrasound-enhanced thrombolysis: EKOS EndoWave infusion catheter system. Semin Intervent Radiol 2008; 25 (01) 37-41
- 41 Braaten JV, Goss RA, Francis CW. Ultrasound reversibly disaggregates fibrin fibers. Thromb Haemost 1997; 78 (03) 1063-1068
- 42 Francis CW, Blinc A, Lee S, Cox C. Ultrasound accelerates transport of recombinant tissue plasminogen activator into clots. Ultrasound Med Biol 1995; 21 (03) 419-424
- 43 Liang NL, Avgerinos ED, Marone LK, Singh MJ, Makaroun MS, Chaer RA. Comparative outcomes of ultrasound-assisted thrombolysis and standard catheter-directed thrombolysis in the treatment of acute pulmonary embolism. Vasc Endovascular Surg 2016; 50 (06) 405-410
- 44 Rao G, Xu H, Wang JJ. , et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute pulmonary embolism: a multicenter comparison of patient-centered outcomes. Vasc Med 2019; 24 (03) 241-247
- 45 Engelberger RP, Spirk D, Willenberg T. , et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis. Circ Cardiovasc Interv 2015; 8 (01) e002027
- 46 De Gregorio MA, Guirola JA, Lahuerta C, Serrano C, Figueredo AL, Kuo WT. Interventional radiology treatment for pulmonary embolism. World J Radiol 2017; 9 (07) 295-303
- 47 Lichtenberg M, Stahlhoff WF, Özkapi A, de Graaf R, Breuckmann F. Safety, procedural success and outcome of the Aspirex®S endovascular thrombectomy system in the treatment of iliofemoral deep vein thrombosis - data from the Arnsberg Aspirex registry. Vasa 2019; 48 (04) 341-346
- 48 Nosher JL, Patel A, Jagpal S, Gribbin C, Gendel V. Endovascular treatment of pulmonary embolism: selective review of available techniques. World J Radiol 2017; 9 (12) 426-437
- 49 Konstantinides SV, Meyer G, Becattini C. , et al; ESC Scientific Document Group. 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 (04) 543-603
- 50 Kearon C, Akl EA, Ornelas J. , et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
- 51 Kucher N, Boekstegers P, Müller OJ. , et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 2014; 129 (04) 479-486
- 52 Sista AK. The OPTALYSE PE trial: another step toward understanding the truth about catheter-directed thrombolysis for submassive pulmonary embolism. JACC Cardiovasc Interv 2018; 11 (14) 1411-1413
- 53 Piazza G, Hohlfelder B, Jaff MR. , et al; SEATTLE II Investigators. A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. JACC Cardiovasc Interv 2015; 8 (10) 1382-1392
- 54 Tapson VF, Sterling K, Jones N. , et al. A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial. JACC Cardiovasc Interv 2018; 11 (14) 1401-1410
- 55 Kuo WT, Banerjee A, Kim PS. , et al. Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): initial results from a prospective multicenter registry. Chest 2015; 148 (03) 667-673
- 56 Sista AK, Goldhaber SZ, Vedantham S. , et al. Research priorities in submassive pulmonary embolism: proceedings from a multidisciplinary research consensus panel. J Vasc Interv Radiol 2016; 27 (06) 787-794
- 57 Mismetti P, Laporte S, Pellerin O. , et al; PREPIC2 Study Group. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA 2015; 313 (16) 1627-1635
- 58 Dudzinski DM, Piazza G. Multidisciplinary pulmonary embolism response teams. Circulation 2016; 133 (01) 98-103
- 59 Carroll BJ, Pemberton H, Bauer KA. , et al. Initiation of a multidisciplinary, rapid response team to massive and submassive pulmonary embolism. Am J Cardiol 2017; 120 (08) 1393-1398