Author + information
- Georges El Hayek1,
- Michael McDaniel1,
- Henry Liberman1,
- Chandan Devireddy1,
- Pete Fong2,
- Gautam Kumar3 and
- Wissam Jaber1
Ultrasound-assisted Catheter-Directed Thrombolysis (US-CDT) has emerged as an alternative to systemic thrombolysis, known to be associated with up to 20% risk of major bleeding, in the treatment of high risk pulmonary embolism (PE). However its safety and efficacy remain controversial in the absence of randomized trials. We sought to perform a meta-analysis of the available studies evaluating the use of US-CDT.
We searched Pubmed and Scopus databases for studies that used the US-CDT catheter for the treatment of PE. We excluded studies that involved thrombus fragmentation, rheolytic or rotational thrombectomy, suction thrombectomy or local thrombolysis without Ultrasound assistance. Our safety outcomes included mortality and major bleeding, defined as intracranial hemorrhage (ICH) or bleeding that requires interruption of thrombolytics, transfusion or surgical intervention. Our efficacy outcomes included post procedure reduction in mean pulmonary artery pressure (mPAP), in right ventricle/Left ventricle (RV/LV) ratio and in Miller score after the US-CDT therapy.
We included 15 studies in this analysis comprising 698 patients (Table). There was a 4% mortality rate and 5% risk of major bleeding; Only 3 patients (0.4%) experienced ICH. For efficacy outcomes, we observed a significant reduction in the mPAP by 8 mm Hg (95% CI 5.4-10.7; p<0.0001), a decrease in the RV/LV ratio by 0.35 (95% CI 0.27-0.45) and 10.2 points drop in Miller score (95% CI 7.2-13.2) after therapy.
US-CDT for high risk PE, though effective in reducing early signs of RV strain, is associated with a 5% risk of major bleeding. Randomized trials are needed to evaluate this therapy against anticoagulation alone and against systemic thrombolysis.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention