Author + information
Both catheter-directed thrombolysis (CDT) and ultrasound-assisted thrombolysis (USAT) are novel treatment modalities for patients presenting with intermediate risk pulmonary embolism (PE). Limited direct comparisons of CDT and USAT exist in the current literature. The objective of this study was to compare clinical and safety outcomes of standard CDT and USAT for patients with intermediate and high risk PE.
We retrospectively studied forty-two consecutive patients treated with either CDT or EkoSonic (EKOS) USAT over two years treated at a multi-center health system. All patients enrolled were over 18 years of age and received thrombolytic infusions over at least 12 hours. Patients’ demographic information including age, sex and ethnicity was recorded. Standard statistical methods were used to compare clinical outcomes in longitudinal fashion.
Twenty-two patients (52%) in our study underwent USAT and twenty (48%) patients were treated with bilateral CDT. Background characteristics including age, sex, BMI, smoking history, prevalence of hypertension and diabetes did not differ significantly between two groups. Among all patients studied, 97% had echocardiographic evidence of right ventricular strain on admission. The USAT group’s mean hospital stay was 5+/-7 days compared to 4+/-2 days in the standard CDT group (P = 0.23). Rates of major and minor bleeding were not statistically different between USAT and CDT groups (USAT: 9%; CDT: 5%; P = 1.0). There was no intracranial hemorrhage or deaths in either group.
Using USAT in place of standard CDT for managing intermediate risk PE did not confer a mortality or safety benefit in our study. Length of stay was comparable between both groups. Given the added cost associated with USAT, further studies are needed to determine if adding ultrasound to standard catheter directed thrombolysis confers any additional clinical benefit.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention