Comparison of Percutaneous Ultrasound-Accelerated Thrombolysis versus Catheter-Directed Thrombolysis in Patients with Acute Massive Pulmonary Embolism
Comparison of Percutaneous Ultrasound-Accelerated Thrombolysis versus Catheter-Directed Thrombolysis in Patients with Acute Massive Pulmonary Embolism
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DOI：
10.2310/6670.2009.00063
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发表时间：
2009-11-01
期刊：
影响因子：
1.1
通讯作者：
Kougias, Panagiotis
中科院分区：
文献类型：
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作者：
Lin, Peter H.;Annambhotla, Suman;Kougias, Panagiotis
急性大面积肺栓塞（PE）是一种危及生命的疾病，需要及时和积极的干预措施，包括抗凝、导管导向溶栓（CDT）、机械血栓切除术或外科血栓栓塞切除术。本研究的目的是评价使用EkoSonic血管内系统（EKOS）进行超声加速溶栓或CDT介入治疗的大面积PE患者的治疗结局。在最近10年期间，对所有接受导管定向介入治疗的大面积PE患者的临床记录进行了评价。患者被分为两个治疗组：EKOS与CDT干预。比较两组的治疗结果。在研究期间，25例患者接受了33次导管定向介入治疗大面积PE。其中，EKOS或CDT分别在15例（45%）和18例（55%）手术中进行。在EKOS组中，100%的病例实现了血栓完全清除。在CDT队列中，分别有7例（50%）和2例（14%）病例完成了完全或部分血栓清除。比较基于血栓清除的治疗成功率，与CDT组相比，EKCS治疗改善了治疗结果（p <0.02）。EKOS组和CDT组的平均溶栓时间分别为17.4 +/- 5.23和25.3 +/- 7.35小时（p = 0.03）。EKOS组和CDT组的死亡率分别为9.1%和14.2%（无显著性）。EKOS组和CDT组的治疗相关出血并发症发生率分别为0%和21.4%（p = 0.02）。在导管介入治疗后，两组的米勒评分均显著降低。两组间的相对米勒评分改善无显著差异。使用EkoSonic系统的超声加速溶栓是急性大面积PE患者的有效治疗方式。与CDT相比，这种治疗方式提供了相似的治疗效果，减少了溶栓输注时间和治疗相关并发症。
Acute massive pulmonary embolism (PE) is a life-threatening condition that requires prompt and aggressive interventions, including anticoagulation, catheter-directed thrombolysis (CDT), mechanical thrombectomy, or surgical thromboembolectomy. The aim of this study was to evaluate the treatment outcome in patients with massive PE who were treated with either uItrasound-accelerated thrombolysis using the EkoSonic Endovascular System (EKOS) or CDT intervention. During a recent 10-year period, the clinical records of all patients with massive PE undergoing catheter-directed interventions were evaluated. Patients were divided into two treatment groups: EKOS versus CDT interventions. Comparisons were made with regard to the treatment outcome between the two groups. Twenty-five patients underwent 33 catheter-directed interventions for massive PE during the study period. Among them, EKOS or CDT was performed in 15 (45%) and 18 (55%) procedures, respectively. In the EKOS group, complete thrombus removal was achieved in 100% cases. In the CDT cohort, complete or partial thrombus removal was accomplished in 7 (50%) and 2 (14%) cases, respectively. Comparing treatment success based on thrombus removal, EKCS treatment resulted in an improved treatment outcome compared with the CDT group (p < .02). The mean time of thrombolysis in EKOS and CDT group was 17.4 +/- 5.23 and 25.3 +/- 7.35 hours, respectively (p = .03). The mortality rate in the EKOS and CDT group was 9.1 % and 14.2%, respectively (not significant). Treatment-related hemorrhagic complication rates in the EKOS and CDT group were 0% and 21.4%, respectively (p = .02). A significant reduction in Miller scores was noted in both groups following catheter-based interventions. No significant difference in relative Miller score improvement was observed between groups. Ultrasound-accelerated thrombolysis using the EkoSonic system is an effective treatment modality in patients with acute massive PE. When compared with CDT, this treatment modality provides similar treatment efficacy with reduced thrombolytic infusion time and treatment-related complications.