Filippo RussoMilan, IRCCS San Raffaele Scientific Institute, Italy
Title : Catheter-Directed Treatment of High Risk and Intermediate-High Risk Pulmonary Embolism: A Multicentre Real-World Experience
Aims: Catheter-directed treatments (CDTs) are emerging and attractive therapeutical options in pulmonary embolism (PE), due to the high prevalence of contraindications to systemic thrombolysis (ST). We aimed at evaluating safety and efficacy of CDTs in patients with high risk and intermediate-high risk PE showing contraindications to ST.
Methods and results: We included in our multicentre observational study 104 patients from 5 Interventional Centres: 42 (40.4%) patients with high risk and 62 (59.6%) with intermediate-high risk PE. Rheolytic thrombectomy (RT) was performed in 38 (36.5%), while ultrasound-assisted thrombolysis (USAT) was performed in the remaining 66 (63.4%). Loco-regional thrombolysis was used in 86.5% (rTPA median dose 20 mg, IQR 12-28). Procedural success was reached in 94.7% cases. No procedure-related deaths were reported. Major and minor bleeding occurred in 9.6% and 13.4%, respectively. One lethal intracranial bleeding occurred. Vascular complications occurred in 7% of cases. All-cause mortality was 16.3% in-hospital and 19.3% at one year. A significant improvement in echocardiographic parameters (right ventricle function and pulmonary pressure) was observed from hospital admission to one-year follow-up.
Conclusion: Our experience confirms safety and efficacy of CDTs in a high risk and intermediate high-risk PE patients presenting with contraindications to ST.
Filippo Russo is Senior Consultant in Interventional Cardiology at IRCCS San Raffaele Scientific Institute of Milan, Italy. Main field of interest are complex coronary interventions, TAVI and percutaneous treatment of acute pulmonary embolism and he has over 2500 interventional procedures as first operator. He has been author or co-author of several publication in field of interventional cardiology in the main peer reviewed journals as New England Journal of Medicine, Lancet, Journal of American College of Cardiology, Eurointervention and International Journal of Cardiology