Catheter-directed interventions for pulmonary embolism.
Ajar KocharBrian A BergmarkPublished in: European heart journal. Acute cardiovascular care (2022)
Pulmonary embolism (PE) is common, life-threatening, and often recurrent among survivors. The clinical manifestations of PE range from incidental detection to sudden death, with approximately one-third of PE deaths occurring suddenly. State-of-the-art management of acute PE relies on early detection, risk stratification based on clinical, imaging, and biomarker criteria, and multidisciplinary decision-making. The primary goal of catheter-directed interventions for acute PE is to interrupt the cycle of right ventricular failure, hypoperfusion, and oxygen supply/demand imbalance by increasing the cross-sectional area of the patent pulmonary vasculature, thereby lowering resistance and alleviating V/Q mismatch. Innovations in percutaneous interventions have led to several approaches described in this review: rheolytic thrombectomy, catheter-directed thrombolysis, and aspiration or mechanical thrombectomy. The central challenge moving forward will be integrating growing clinical trial evidence into multidisciplinary, individualized care pathways meeting the diverse clinical needs of patients presenting with acute PE.
Keyphrases
- pulmonary embolism
- liver failure
- ultrasound guided
- inferior vena cava
- respiratory failure
- clinical trial
- physical activity
- cross sectional
- drug induced
- aortic dissection
- decision making
- healthcare
- quality improvement
- high resolution
- palliative care
- hepatitis b virus
- pulmonary hypertension
- acute ischemic stroke
- cognitive impairment
- chronic pain
- pain management
- open label
- mass spectrometry
- study protocol
- phase ii