Large-Bore Aspiration Thrombectomy versus Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Propensity Score-Matched Comparison.

Autor:	Graif A; Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713. Electronic address: Agraif@christianacare.org., Patel KD; Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713., Wimmer NJ; Department of Cardiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713., Kimbiris G; Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713., Grilli CJ; Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713., Upparapalli D; Department of Cardiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713., Kaneria AR; Department of Cardiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713., Leung DA; Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713.
Jazyk:	angličtina
Zdroj:	Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2020 Dec; Vol. 31 (12), pp. 2052-2059. Date of Electronic Publication: 2020 Nov 09.
DOI:	10.1016/j.jvir.2020.08.028
Abstrakt:	Purpose: To compare effectiveness and safety of large-bore aspiration thrombectomy (LBAT) with catheter-directed thrombolysis (CDT) for treatment of acute massive and submassive pulmonary embolism (PE). Materials and Methods: This retrospective review included patients with acute PE treated with LBAT or CDT using tissue plasminogen activator (tPA) between December 2009 and May 2020. A propensity score based on Pulmonary Embolism Severity Index class and PE severity (massive vs submassive) was calculated, and 26 LBAT cases (age 60.2 y ± 17.1, 14/26 women) were matched with 26 CDT cases (age 59.7 y ± 14.2, 14/26 women). Results: The CDT group had 22.1 mg ± 8.1 tPA infused over 21.2 h ± 6.6. Both groups demonstrated similar initial and final systolic pulmonary artery pressure (PAP) (LBAT: 54.5 mm Hg ± 12.9 vs CDT: 54.5 mm Hg ± 16.3, P = .8, and LBAT: 42.5 mm Hg ± 14.1 vs CDT: 42.6 mm Hg ± 12.1, P = .8, respectively) and similar reductions in heart rate (LBAT: -5.4 beats/min ± 19.2 vs CDT: -9.6 beats/min ± 15.8, P = .4). CDT demonstrated a higher reduction in Miller score (-10.1 ± 3.9 vs -7.5 ± 3.8, P = .02). LBAT resulted in 1 minor hemorrhagic complication and 2 procedure-related mortalities, and CDT resulted in 1 minor and 1 major hemorrhagic complication. Conclusions: LBAT and CDT resulted in similar reductions of PAP and heart rate when used to treat acute PE. CDT reduced thrombus burden to a greater degree. Although hemorrhagic complications rates were not significantly different, the LBAT group demonstrated a higher rate of procedure-related mortality. Larger studies are needed to compare the safety of these techniques. (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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