March Spotlight — Radiology: Advances in endovascular management of pulmonary embolism

By Joseph Bonn, MD, Director of Interventional Radiology, Lankenau Medical Center

 Acute pulmonary embolism (PE) is a highly prevalent, serious medical event, striking over 600,000 Americans each year, resulting in between 150,000 and 200,000 deaths annually, and burdening an unknown number of patients with the lifelong sequelae of chronic pulmonary hypertension1. Patients with massive and submassive PE, defined by clinical, serologic and imaging criteria, have an increased morbidity and mortality over those patients with less severe forms of PE, as the strain placed on the right heart working against occlusive emboli can trigger a cascade effect leading to heart failure and arrest. It has been shown that this patient subgroup may benefit from a more proactive treatment regimen to remove thrombus, acting directly to reduce right heart strain, rather than simply to anticoagulate.2,3

 A new consensus treatment protocol was recently developed by Lankenau pulmonary intensivists and interventional radiologists to guide use of the new technology of EKOS ultrasound-assisted catheter thrombolysis system in patients with massive and submassive PE. This endovascular technology, proven last year in a prospective, randomized clinical trial4, relies on direct intrathrombus delivery of recombinant tPA through multisidehole catheters, along with catheter-delivered ultrasound energy transmitted directly into the thrombus to loosen its protein bonds and enhance tPA penetration. It has made thrombolysis more effective, more efficient, and safer, with fewer side effects, resulting in rapid improvements in pulmonary circulation and oxygenation, while reducing pulmonary hypertension, right heart strain, and oxygen demand.

This exciting, life saving procedure was introduced recently at Lankenau Medical Center.  In view of the success we have experienced thus far, we hope to make this procedure available soon at the other hospitals of the Main Line Health System.

 Requests for consultations for patients with massive and submassive PE for EKOS ultrasound-assisted pulmonary thrombolysis may be made to the Pulmonary Division at LankenauMedicalCenter. 

 

1 Intern Med J 2008;38:657-67.

2 Circulation 2006;113:577-82.

3 Chest 2008;133:358-62.

4 ACC March 2013.

 

 

This exciting, life saving procedure was introduced recently at Lankenau Medical Center.  In view of the success we have experienced thus far, we hope to

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