Current Endovascular Treatment Options in Acute Pulmonary Embolism

Kelli Moore, Jeff Kunin, Mohammed Alnijoumi, Prashant Nagpal, Ambarish P Bhat, Kelli Moore, Jeff Kunin, Mohammed Alnijoumi, Prashant Nagpal, Ambarish P Bhat

Abstract

Acute pulmonary embolism (PE) is a significant cause of mortality and morbidity across the globe. Over the last few decades, there have been major therapeutic advances in acute PE management, including catheter-based therapy. However, the effectiveness of catheter-based therapy in acute PE is not supported by Level I evidence, making the use of this promising treatment rather controversial and ambiguous. In this paper, we discuss the risk stratification of acute PE and review the medical and endovascular treatment options. We also summarize and review the data supporting the use of endovascular treatment options in acute PE and describe the potential role of the PE response team.

Keywords: Chronic thromboembolic pulmonary hypertension; FlowTriever; Massive pulmonary embolism; Pulmonary embolism response team; Thrombectomy.

Conflict of interest statement

Dr. Nagpal (PN) receives grant support from National Institutes of Health (NIH) and Carver College of Medicine, Iowa City unrelated to this project. The other authors have no conflict.

© 2020 Published by Scientific Scholar on behalf of Journal of Clinical Imaging Science.

Figures

Figure 1:
Figure 1:
ABCD of PE management. ST-Systemic thrombolysis, sPESI: Simplified pulmonary embolism severity index, ST: Systemic thrombolysis.
Figure 2:
Figure 2:
Chest radiograph of a 60-year-old male with high-risk PE after placement of EKOS catheters in both the pulmonary arteries (black arrows) for the purpose of targeted TPA delivery over 12–24 h.
Figure 3:
Figure 3:
Coronal (a) and axial CT angiogram (b) of the chest in a 45-year-old male showing bilateral extensive pulmonary embolism (white arrows). Digital subtraction angiogram (DSA) of the right pulmonary artery in the same patient (c) showing multiple filling defects in the upper and lower lobar pulmonary arteries (white arrows). Follow-up DSA (d) of the same patient after mechanical thrombectomy with the FlowTriever device (black arrows) through a 22 F sheath showing near complete clearance of the clot. The aspirated clot is on shown in picture (e) (white arrows).
Figure 4:
Figure 4:
EKOS catheter (black arrow heads) with the ultrasound core wire (black arrow). Image provided courtesy of Boston Scientific. ©2020 Boston Scientific Corporation or its affiliates. All rights reserved.
Figure 5:
Figure 5:
The Angiojet thrombectomy catheter (dotted black arrow) with its dive unit/pump (solid black arrow). Image provided courtesy of Boston Scientific. ©2020 Boston Scientific Corporation or its affiliates. All rights reserved.
Figure 6:
Figure 6:
Picture illustration of the INARI FlowTriever and its components. The 20 F aspiration guide catheter (a), the proprietary syringe (b) (black arrows) and nitinol discs, (c) (black arrows) engaging the clot (white arrow heads). Used with permission from Inari Medical, Irvine, CA.
Figure 7:
Figure 7:
Illustration (a) of the Indigo CAT8 system with its engine and wire separator (SEP8). (b) CAT8 with deployment of the wire separator (SEP8) in the clot before aspiration. sed with permission from Penumbra, Alameda, CA.

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