Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute pulmonary embolism: A multicenter comparison of patient-centered outcomes

Vasc Med. 2019 Jun;24(3):241-247. doi: 10.1177/1358863X19838334. Epub 2019 Mar 27.

Abstract

Both catheter-directed thrombolysis (CDT) and ultrasound-assisted thrombolysis (USAT) are novel treatment modalities for patients presenting with acute pulmonary embolism (PE). The objective of this study was to compare clinical and quality-of-life (QOL) outcomes for patients undergoing either treatment modality. We retrospectively studied 70 consecutive patients treated with either CDT or USAT over 3 years at a multicenter health system. The primary clinical efficacy endpoint was right ventricular systolic pressure (RVSP) reduction post-procedurally. Safety endpoints were mortality and bleeding incidents based on Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries (GUSTO) criteria. Long-term QOL was assessed using the 36-Item Short-Form Health Survey (SF-36) via phone interview. Thirty-seven patients (53%) in our study underwent USAT and 33 (47%) patients were treated with conventional CDT. Among all patients studied, 96% had echocardiographic evidence for right ventricular strain on admission. Mean RVSP decreased by 18 ± 13 mmHg in the USAT group post-procedurally as compared to 14 ± 16 mmHg in the CDT group, without significant difference between groups ( p = 0.31). Rates of moderate and severe bleeding were largely identical between USAT and CDT groups (USAT: 3%; CDT: 0%; p = 0.09). There was no death in either group during admission. At long-term follow-up, there was no significant difference in QOL between both treatment modalities in all eight functional domains of SF-36. Our retrospective study demonstrated using USAT over conventional CDT for acute submassive or massive PE did not yield additional clinical, safety, or long-term QOL benefit.

Keywords: bleeding; catheter-directed thrombolysis; endovascular therapy; pulmonary embolism (PE); quality of life; thrombolytic therapy; ultrasound-assisted thrombolysis.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Catheterization, Peripheral* / adverse effects
  • Catheterization, Peripheral* / mortality
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Hemorrhage / chemically induced
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / therapy*
  • Retrospective Studies
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / methods*
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome
  • Ultrasonic Therapy / adverse effects
  • Ultrasonic Therapy / methods*

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator