Paradoxical pulmonary artery systolic pressure response with catheter-directed therapies for pulmonary embolism.

Autor:	Ho P; Division of Pulmonary & Critical Care Medicine, Lankenau Medical Center, Wynnewood, PA, United States of America., Al-Chami F; Division of Internal Medicine, Lankenau Medical Center, Wynnewood, PA, United States of America., Caroline M; Division of Interventional Cardiology, Lankenau Medical Center, Wynnewood, PA, United States of America., Gnall E; Division of Interventional Cardiology, Lankenau Medical Center, Wynnewood, PA, United States of America., Bonn J; Division of Interventional Radiology, Lankenau Medical Center, Wynnewood, PA, United States of America., Greenspon L; Division of Pulmonary & Critical Care Medicine, Lankenau Medical Center, Wynnewood, PA, United States of America.
Jazyk:	angličtina
Zdroj:	American heart journal plus : cardiology research and practice [Am Heart J Plus] 2023 Sep 02; Vol. 34, pp. 100320. Date of Electronic Publication: 2023 Sep 02 (Print Publication: 2023).
DOI:	10.1016/j.ahjo.2023.100320
Abstrakt:	Background: Early data on use of catheter-directed therapies (CDT) for treatment of Intermediate or High-Risk pulmonary embolism (PE) show improvement in pulmonary artery systolic pressures (PAsP) and RV/LV ratios. Occasionally a paradoxical rise in PAsP was observed with CDT utilizing ultrasound-assisted thrombolysis (USAT). It is unclear whether this pattern is seen with CDT utilizing mechanical aspiration. Objectives: To investigate and compare the changes in PAsP between those who underwent CDT with USAT to those with mechanical aspiration. Methods: A retrospective analysis of those diagnosed with Intermediate or High-Risk PE who underwent CDT using USAT or mechanical aspiration from 7/2013 to 3/2023. The primary outcome was comparison of PAsP changes between the two modalities. Secondary outcomes include length of stay, mortality, and bleeding complications. Results: A total of 142 patients were analyzed, of which 93 underwent USAT and 49 underwent mechanical thrombectomy. The mechanical thrombectomy group had significantly lower post-intervention PAsP than the USAT group (42.2 ± 13.4 mmHg vs 54.5 ± 15.2 mmHg, p  < 0.0001) and a greater adjusted mean reduction (-16.5 ± 2.7 vs. -7.7 ± 3.2 mmHg. p < 0.0001). A higher frequency of a paradoxical rise in PAsP was observed in the USAT group (22 % vs 4.1 %, p  < 0.001). Conclusions: CDT utilizing mechanical thrombectomy was associated with lower post-interventional PAsP and greater mean negative change compared to USAT. Occasional paradoxical rises in PAsP were observed with both types of CDT, but they were more frequent with USAT. Hemodynamic monitoring should be considered after CDT. Condensed Unstructured Abstract: We report a retrospective comparison of changes to pulmonary artery systolic pressures (PAsPs) between catheter-directed ultrasound-assisted thrombolysis (USAT) and catheter-directed mechanical thrombectomy in Intermediate and High-Risk pulmonary embolism. Those treated with mechanical thrombectomy compared to USAT had significantly lower post-interventional PAsP (42.2 ± 13.4 mmHg vs 54.5 ± 15.2 mmHg, p  < 0.0001) and a greater adjusted mean reduction (-16.2 ± 2.7 vs. -7.5 ± 3.2 mmHg, p < 0.0001). A paradoxical rise in PAsP was observed more frequently in the USAT group than the mechanical thrombectomy group (22 % vs 4.1 %, p  < 0.001). Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lee Greenspon reports a relationship with Inari Medical that includes: funding grants. Lee Greenspon reports a relationship with 10.13039/100008497Boston Scientific Corp. that includes: funding grants. Joseph Bonn reports a relationship with Boston Scientific Corp that includes: funding grants. (© 2023 The Authors.)
Databáze:	MEDLINE
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