Skip to main content
Top

24-04-2024 | Acute Pulmonary Embolism | Structural Heart Disease (S Vakamudi, Section Editor) Free for a limited time

Evidence-Based Update on Transcatheter Therapies for Pulmonary Embolism

Authors: Peter Monteleone, Akash Patel, Jonathan Paul

Published in: Current Cardiology Reports

Login to get access

Abstract

Purpose of Review

Pulmonary embolism (PE) remains a leading cause of cardiovascular morbidity and mortality. Multiple new therapies are in development and under study to improve our contemporary care of patients with PE. We review and compare here these novel therapeutics and technologies.

Recent Findings

Multiple novel therapeutic devices have been developed and are under active study. This work has advanced the care of patients with intermediate and high-risk PE.

Summary

Novel therapies are improving care of complex PE patients. These have inspired large multicenter international randomized controlled trials that are actively recruiting patients to advance the care of PE. These studies will work towards advancing guidelines for clinical care of patients with PE.
Literature
1.
go back to reference Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163:1711–7.CrossRefPubMed Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163:1711–7.CrossRefPubMed
2.
go back to reference Alotaibi GS, Wu C, Senthilselvan A, McMurtry MS. Secular trends in incidence and mortality of acute venous thromboembolism: the AB-VTE population-based study. Am J Med. 2016;129(879):e19-25. Alotaibi GS, Wu C, Senthilselvan A, McMurtry MS. Secular trends in incidence and mortality of acute venous thromboembolism: the AB-VTE population-based study. Am J Med. 2016;129(879):e19-25.
3.
go back to reference Fernandez MM, Hogue S, Preblick R, Kwong WJ. Review of the cost of venous thromboembolism. ClinicoEconomics and outcomes research : CEOR. 2015;7:451–62.CrossRefPubMed Fernandez MM, Hogue S, Preblick R, Kwong WJ. Review of the cost of venous thromboembolism. ClinicoEconomics and outcomes research : CEOR. 2015;7:451–62.CrossRefPubMed
4.
go back to reference Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4:4693–738.CrossRefPubMedPubMedCentral Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4:4693–738.CrossRefPubMedPubMedCentral
5.
go back to reference • Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54. The ESC guidelines present a commonly used algorithm for risk stratification of patients with PE. This contemporary stratification system is frequently implemented in current practice and decision making in the care of PE patients. • Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54. The ESC guidelines present a commonly used algorithm for risk stratification of patients with PE. This contemporary stratification system is frequently implemented in current practice and decision making in the care of PE patients.
6.
go back to reference Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315–52.CrossRefPubMed Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315–52.CrossRefPubMed
7.
go back to reference Frémont B, Pacouret G, Jacobi D, Puglisi R, Charbonnier B, de Labriolle A. Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients. Chest. 2008;133:358–62.CrossRefPubMed Frémont B, Pacouret G, Jacobi D, Puglisi R, Charbonnier B, de Labriolle A. Prognostic value of echocardiographic right/left ventricular end-diastolic diameter ratio in patients with acute pulmonary embolism: results from a monocenter registry of 1,416 patients. Chest. 2008;133:358–62.CrossRefPubMed
8.
go back to reference van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005;235:798–803.CrossRefPubMed van der Meer RW, Pattynama PM, van Strijen MJ, et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology. 2005;235:798–803.CrossRefPubMed
9.
go back to reference Grifoni S, Vanni S, Magazzini S, et al. Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events. Arch Intern Med. 2006;166:2151–6.CrossRefPubMed Grifoni S, Vanni S, Magazzini S, et al. Association of persistent right ventricular dysfunction at hospital discharge after acute pulmonary embolism with recurrent thromboembolic events. Arch Intern Med. 2006;166:2151–6.CrossRefPubMed
10.
go back to reference Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113:577–82.CrossRefPubMed Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113:577–82.CrossRefPubMed
11.
go back to reference • Natanzon SS, Fardman A, Chernomordik F, et al. PESI score for predicting clinical outcomes in PE patients with right ventricular involvement. Heart and vessels. 2022;37:489–95. This work presents the PESI risk score for risk stratifying patients with pulmonary embolism to guide decision making in therapy.CrossRefPubMed • Natanzon SS, Fardman A, Chernomordik F, et al. PESI score for predicting clinical outcomes in PE patients with right ventricular involvement. Heart and vessels. 2022;37:489–95. This work presents the PESI risk score for risk stratifying patients with pulmonary embolism to guide decision making in therapy.CrossRefPubMed
13.
go back to reference Urokinase pulmonary embolism trial. Phase 1 results: a cooperative study. JAMA. 1970;214:2163–72. Urokinase pulmonary embolism trial. Phase 1 results: a cooperative study. JAMA. 1970;214:2163–72.
14.
go back to reference Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370:1402–11.CrossRefPubMed Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med. 2014;370:1402–11.CrossRefPubMed
15.
go back to reference 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;69:1536–44.CrossRefPubMed 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;69:1536–44.CrossRefPubMed
16.
go back to reference 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;36:605–14.CrossRefPubMed 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;36:605–14.CrossRefPubMed
17.
go back to reference Schmitz-Rode T, Janssens U, Duda SH, Erley CM, Günther RW. Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter. J Am Coll Cardiol. 2000;36:375–80.CrossRefPubMed Schmitz-Rode T, Janssens U, Duda SH, Erley CM, Günther RW. Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter. J Am Coll Cardiol. 2000;36:375–80.CrossRefPubMed
18.
go back to reference Bonvini RF, Righini M, Roffi M. Angiojet rheolytic thrombectomy in massive pulmonary embolism: locally efficacious but systemically deleterious? J Vasc Interv Radiol. 2010;21:1774–6; author reply 6-7.CrossRefPubMed Bonvini RF, Righini M, Roffi M. Angiojet rheolytic thrombectomy in massive pulmonary embolism: locally efficacious but systemically deleterious? J Vasc Interv Radiol. 2010;21:1774–6; author reply 6-7.CrossRefPubMed
19.
go back to reference Tapson VF, Gurbel PA, Witty LA, Pieper KS, Stack RS. Pharmacomechanical thrombolysis of experimental pulmonary emboli. Rapid low-dose intraembolic therapy Chest. 1994;106:1558–62.PubMed Tapson VF, Gurbel PA, Witty LA, Pieper KS, Stack RS. Pharmacomechanical thrombolysis of experimental pulmonary emboli. Rapid low-dose intraembolic therapy Chest. 1994;106:1558–62.PubMed
20.
go back to reference Blinc A, Francis CW, Trudnowski JL, Carstensen EL. Characterization of ultrasound-potentiated fibrinolysis in vitro. Blood. 1993;81:2636–43.CrossRefPubMed Blinc A, Francis CW, Trudnowski JL, Carstensen EL. Characterization of ultrasound-potentiated fibrinolysis in vitro. Blood. 1993;81:2636–43.CrossRefPubMed
21.
go back to reference Francis CW, Blinc A, Lee S, Cox C. Ultrasound accelerates transport of recombinant tissue plasminogen activator into clots. Ultrasound Med Biol. 1995;21:419–24.CrossRefPubMed Francis CW, Blinc A, Lee S, Cox C. Ultrasound accelerates transport of recombinant tissue plasminogen activator into clots. Ultrasound Med Biol. 1995;21:419–24.CrossRefPubMed
22.
go back to reference Owens CA. Ultrasound-enhanced thrombolysis: EKOS EndoWave infusion catheter system. Semin Interv Radiol. 2008;25:37–41.CrossRef Owens CA. Ultrasound-enhanced thrombolysis: EKOS EndoWave infusion catheter system. Semin Interv Radiol. 2008;25:37–41.CrossRef
23.
go back to reference 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;129:479–86.CrossRefPubMed 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;129:479–86.CrossRefPubMed
24.
go back to reference Piazza G, Hohlfelder B, Jaff MR, et al. 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;8:1382–92.CrossRefPubMed Piazza G, Hohlfelder B, Jaff MR, et al. 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;8:1382–92.CrossRefPubMed
25.
go back to reference 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;11:1401–10.CrossRefPubMed 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;11:1401–10.CrossRefPubMed
27.
go back to reference Sterling K. KNOCOUT PE: retrospective and prospective international EKoSoNic registry of the treatment and clinical outcomes of patients with pulmonary embolism. Vascular InterVentional Advances Conference; 2021; Las Vegas, NV. Sterling K. KNOCOUT PE: retrospective and prospective international EKoSoNic registry of the treatment and clinical outcomes of patients with pulmonary embolism. Vascular InterVentional Advances Conference; 2021; Las Vegas, NV.
28.
go back to reference Avgerinos ED, Jaber W, Lacomis J, et al. Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE trial. JACC Cardiovasc Interv. 2021;14:1364–73.CrossRefPubMedPubMedCentral Avgerinos ED, Jaber W, Lacomis J, et al. Randomized trial comparing standard versus ultrasound-assisted thrombolysis for submassive pulmonary embolism: the SUNSET sPE trial. JACC Cardiovasc Interv. 2021;14:1364–73.CrossRefPubMedPubMedCentral
29.
go back to reference Klok FA, Piazza G, Sharp ASP, Ní Ainle F, Jaff MR, Chauhan N, et al. Ultrasound-facilitated,catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: Rationale and design of the HI-PEITHO study. Am Heart J. 2022;251:43–53. https://doi.org/10.1016/j.ahj.2022.05.011. Epub 2022 May 16. PMID: 35588898. Klok FA, Piazza G, Sharp ASP, Ní Ainle F, Jaff MR, Chauhan N, et al. Ultrasound-facilitated,catheter-directed thrombolysis vs anticoagulation alone for acute intermediate-high-risk pulmonary embolism: Rationale and design of the HI-PEITHO study. Am Heart J. 2022;251:43–53. https://​doi.​org/​10.​1016/​j.​ahj.​2022.​05.​011. Epub 2022 May 16. PMID: 35588898.
30.
go back to reference Sista AK, Bhatheja R, Rali P, et al. First-in-human study to assess the safety and feasibility of the bashir endovascular catheter for the treatment of acute intermediate-risk pulmonary embolism. Circ Cardiovasc Interv. 2021;14: e009611.CrossRefPubMed Sista AK, Bhatheja R, Rali P, et al. First-in-human study to assess the safety and feasibility of the bashir endovascular catheter for the treatment of acute intermediate-risk pulmonary embolism. Circ Cardiovasc Interv. 2021;14: e009611.CrossRefPubMed
31.
go back to reference Bashir R, Foster M, Iskander A, et al. Pharmacomechanical catheter-directed thrombolysis with the bashir endovascular catheter for acute pulmonary embolism: the RESCUE study. JACC Cardiovasc Interv. 2022;15:2427–36.CrossRefPubMed Bashir R, Foster M, Iskander A, et al. Pharmacomechanical catheter-directed thrombolysis with the bashir endovascular catheter for acute pulmonary embolism: the RESCUE study. JACC Cardiovasc Interv. 2022;15:2427–36.CrossRefPubMed
32.
go back to reference Tu T, Toma C, Tapson VF, et al. A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study. JACC Cardiovasc Interv. 2019;12:859–69.CrossRefPubMed Tu T, Toma C, Tapson VF, et al. A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE study. JACC Cardiovasc Interv. 2019;12:859–69.CrossRefPubMed
33.
go back to reference Toma C, Bunte MC, Cho KH, et al. Percutaneous mechanical thrombectomy in a real-world pulmonary embolism population: interim results of the FLASH registry. Catheter Cardiovasc Interv: J Soc Cardiovasc Angiogr Interv. 2022;99:1345–55.CrossRef Toma C, Bunte MC, Cho KH, et al. Percutaneous mechanical thrombectomy in a real-world pulmonary embolism population: interim results of the FLASH registry. Catheter Cardiovasc Interv: J Soc Cardiovasc Angiogr Interv. 2022;99:1345–55.CrossRef
34.
go back to reference Silver MJ, Gibson CM, Giri J, Khandhar S, Jaber W, Toma C, et al. Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy or Other Contemporary Therapies: Results From the FLAME Study. Circ Cardiovasc Interv. 2023:16(10):e013406. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013406. Epub 2023. PMID: 37847768; PMCID: PMC10573120. Silver MJ, Gibson CM, Giri J, Khandhar S, Jaber W, Toma C, et al. Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy or Other Contemporary Therapies: Results From the FLAME Study. Circ Cardiovasc Interv. 2023:16(10):e013406. https://​doi.​org/​10.​1161/​CIRCINTERVENTION​S.​123.​013406. Epub 2023. PMID: 37847768; PMCID: PMC10573120.
35.
go back to reference Saxon RR, Benenati JF, Teigen C, Adams GL, Sewall LE. Utility of a power aspiration-based extraction technique as an initial and secondary approach in the treatment of peripheral arterial thromboembolism: results of the multicenter PRISM trial. J Vasc Interv Radiol. 2018;29:92–100.CrossRefPubMed Saxon RR, Benenati JF, Teigen C, Adams GL, Sewall LE. Utility of a power aspiration-based extraction technique as an initial and secondary approach in the treatment of peripheral arterial thromboembolism: results of the multicenter PRISM trial. J Vasc Interv Radiol. 2018;29:92–100.CrossRefPubMed
36.
go back to reference Sista AK, Horowitz JM, Tapson VF, et al. Indigo aspiration system for treatment of pulmonary embolism: results of the EXTRACT-PE trial. JACC Cardiovasc Interv. 2021;14:319–29.CrossRefPubMed Sista AK, Horowitz JM, Tapson VF, et al. Indigo aspiration system for treatment of pulmonary embolism: results of the EXTRACT-PE trial. JACC Cardiovasc Interv. 2021;14:319–29.CrossRefPubMed
37.
go back to reference Robertson B, Neville E, Muck A, et al. Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device. J Vasc Surg Venous Lymphat Disord. 2022;10:594–601.CrossRefPubMed Robertson B, Neville E, Muck A, et al. Technical success and short-term results from mechanical thrombectomy for lower extremity iliofemoral deep vein thrombosis using a computer aided mechanical aspiration thrombectomy device. J Vasc Surg Venous Lymphat Disord. 2022;10:594–601.CrossRefPubMed
38.
go back to reference Enezate T, Alkhatib D, Raja J, Chinta V, Patel M, Omran J. AngioVac for minimally invasive removal of intravascular and intracardiac masses: a systematic review. Curr Cardiol Rep. 2022;24:377–82.CrossRefPubMed Enezate T, Alkhatib D, Raja J, Chinta V, Patel M, Omran J. AngioVac for minimally invasive removal of intravascular and intracardiac masses: a systematic review. Curr Cardiol Rep. 2022;24:377–82.CrossRefPubMed
40.
go back to reference Ain DL, Albaghdadi M, Giri J, et al. Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: two eras at an urban tertiary care hospital. Vascular medicine (London, England). 2018;23:60–4.CrossRefPubMed Ain DL, Albaghdadi M, Giri J, et al. Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: two eras at an urban tertiary care hospital. Vascular medicine (London, England). 2018;23:60–4.CrossRefPubMed
41.
go back to reference Karami M, Mandigers L, Miranda DDR, et al. Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: a systematic review and meta-analysis. J Crit Care. 2021;64:245–54.CrossRefPubMed Karami M, Mandigers L, Miranda DDR, et al. Survival of patients with acute pulmonary embolism treated with venoarterial extracorporeal membrane oxygenation: a systematic review and meta-analysis. J Crit Care. 2021;64:245–54.CrossRefPubMed
42.
go back to reference Zuin M, Rigatelli G, Daggubati R, Nguyen T, Roncon L. Impella RP in hemodynamically unstable patients with acute pulmonary embolism. J Artif Organs: J Japanese Soc Artif Organs. 2020;23:105–12.CrossRef Zuin M, Rigatelli G, Daggubati R, Nguyen T, Roncon L. Impella RP in hemodynamically unstable patients with acute pulmonary embolism. J Artif Organs: J Japanese Soc Artif Organs. 2020;23:105–12.CrossRef
Metadata
Title
Evidence-Based Update on Transcatheter Therapies for Pulmonary Embolism
Authors
Peter Monteleone
Akash Patel
Jonathan Paul
Publication date
24-04-2024
Publisher
Springer US
Published in
Current Cardiology Reports
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-024-02060-3