Effect of Pharmacomechanical Catheter-Directed Thrombolysis on Segmental Artery Occlusions: Insights From the RESCUE Trial.
Effect of Pharmacomechanical Catheter-Directed Thrombolysis on Segmental Artery Occlusions: Insights From the RESCUE Trial.
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药物机械导管定向溶栓对节段性动脉闭塞的影响：RESCUE 试验的见解。
DOI：
10.1016/j.jacadv.2023.100670
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Rosenfield,Kenneth
中科院分区：
文献类型：
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作者：
Bashir,Riyaz;Piazza,Gregory;Firth,Brian;Ouriel,Kenneth;Sista,Akhilesh;Rali,Parth;Comerota,Anthony;Lakhter,Vladimir;Iskander,Ayman;Foster,Malcolm;Gandhi,Ripal;Darki,Amir;Lookstein,Robert;Rosenfield,Kenneth
急性肺栓塞（PE）远端血管容积减少是30天和90天死亡率的重要预测因子。可能的原因是肺动脉阻塞。药物机械导管定向溶栓（PM-CDT）对这些肺动脉（PA）分支闭塞的影响尚不清楚。ObjectivesRESCUE研究评价了PM-CDT与Bashir血管内导管在急性中危PE患者中的应用。本分析评估PA闭塞使用核心实验室数据之前和之后PM-CDT therapeutic.MethodsThe基线和治疗后48小时对比增强胸部计算机断层扫描血管造影的PE患者与右心室扩张参加了RESCUE试验。主要分析的是在48小时后与基线相比，使用McNemar的test.ResultsA共107例患者参加了18个美国网站的部分和近端PA分支与总或次总（>65%）闭塞的数量的变化。在PM-CDT后48小时，完全或次全闭塞的PA节段性分支的数量从40.5%减少到11.7%（P< 0.0001）。近端PA分支完全或次全闭塞从28.7%降至11.0%（P< 0.0001）。节段性动脉闭塞的减少与右室/左室比值的降低幅度显著相关（相关系数为0.287 [95%CI：0.102-0.452];P= 0.0026），而近端PA动脉中则没有（相关系数0.132 [95%CI：0.059-0.314]P= 0.173）。结论Bashir导管PM-CDT与节段性和近端PA的完全和次全闭塞显著减少相关。
BackgroundReduction in distal vascular volume in acute pulmonary embolism (PE) is a significant predictor of 30- and 90-day mortality. The likely cause of this is pulmonary arterial obstruction. The effect of pharmacomechanical catheter-directed thrombolysis (PM-CDT) on the occlusions of these pulmonary artery (PA) branches is not known.ObjectivesThe RESCUE study evaluated PM-CDT with the Bashir endovascular catheter in patients with acute intermediate-risk PE. This analysis assessed PA occlusions using core laboratory data before and after PM-CDT therapy.MethodsThe baseline and 48-hour post-treatment contrast-enhanced chest computed tomography angiography of PE patients with right ventricular dilatation enrolled in the RESCUE trial were used. The primary analysis was the change in the number of segmental and proximal PA branches with total or subtotal (>65%) occlusions after 48 hours compared to baseline using McNemar’s test.ResultsA total of 107 patients enrolled across 18 United States sites comprised this analysis. At 48 hours post-PM-CDT, the number of segmental PA branches with total or subtotal occlusions decreased from 40.5% to 11.7% (P< 0.0001). Proximal PA branch total or subtotal occlusions decreased from 28.7% to 11.0% (P< 0.0001). The reduction in segmental artery occlusions correlated significantly with the magnitude of reduction in right ventricular/left ventricular ratio (correlation coefficient of 0.287 [95% CI: 0.102-0.452];P= 0.0026), whereas that in the proximal PA arteries did not (correlation coefficient of 0.132 [95% CI: 0.059-0.314]P= 0.173).ConclusionsPM-CDT with the Bashir catheter was associated with a significant reduction in total and subtotal occlusion of segmental and proximal PAs.