A Case of Failure of EkoSonic™ Endovascular System in the Treatment of Submassive Pulmonary Embolism
| Autor: | Ekta Tirthani, Salem Thabet, Mina Said |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Pulmonology medicine.medical_treatment half dose systemic thrombolytic therapy 030204 cardiovascular system & hematology Chest pain ultrasound assisted catheter directed thrombolysis 03 medical and health sciences 0302 clinical medicine ekos Internal medicine medicine Internal Medicine Thrombus biology submassive pulmonary embolism business.industry General Engineering Acute kidney injury Thrombolysis medicine.disease Brain natriuretic peptide Troponin Pulmonary embolism Pneumonia biology.protein Cardiology medicine.symptom business Radiology failure of ekos 030217 neurology & neurosurgery |
| Zdroj: | Cureus |
| ISSN: | 2168-8184 |
| Popis: | Submassive pulmonary embolism (SPE) is characterized by the presence of right ventricular (RV) strain as visualized on echocardiogram or CT scan with brain natriuretic peptide (BNP) and/or troponin elevation. The condition accounts for 20-25% of all pulmonary embolism (PE) cases. In cases of SPE, catheter-directed thrombolysis (CDT) is generally considered in the presence of severe hypoxemia, worsening RV dysfunction, patients with increasing tachycardia and elevated troponins, free-floating thrombus in the right atrium or RV, and presence of extensive clot burden. EkoSonic (TM) Endovascular System (EKOS;Boston Scientific, Marlborough, MA) has been successfully used to treat cases of PE even where systemic thrombolytic therapy has failed. However, in this article, we describe a unique case of the failure of EKOS in treating a 71-year-old African American man who presented to the hospital with progressively worsening chest pain, shortness of breath, and fatigue. He was suspected to have SPE;however, a CT pulmonary angiogram could not be performed to estimate the clot burden due to an acute kidney injury. He was diagnosed with coronavirus disease 2019 (COVID-19) pneumonia during the hospitalization and had a delayed EKOS procedure with minimal improvement in oxygenation and clot burden. He subsequently underwent half-dose systemic thrombolytic therapy with complete resolution of his symptoms. Given our success with half-dose systemic therapy, we propose that it may be considered as a "rescue therapy" in cases where EKOS fails to deliver results. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|