Pulmonary Embolism: The Era of Catheter-Directed Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: 24 May 2024 | Viewed by 1809

Special Issue Editors


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Guest Editor
Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
Interests: catheter directed tratment in pulmonary embolism; TAVR; complex coronary interventions; chronic total occlusion; acute coronary syndrome

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Guest Editor
Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, 10100 Turin, Italy
Interests: complex coronary interventions; chronic total occlusion recanalisation; intracoronary imaging; left ventricle mechanical support devices
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Special Issue Information

Dear Colleagues,

Catheter-directed treatments (CDTs) consist of a series of catheter-based techniques used to obtain pulmonary vessel reperfusion in acute pulmonary embolism (PE).

According to international guidelines, CDTs should be the considered as a first-line treatment in high-risk PE patients in whom systemic thrombolysis (ST) is contraindicated or has failed, and as bailout in case of hemodynamic decompensation in anticoagulant therapy in intermediate–high-risk patients.

However, due to limited scientific evidence in this field and the absence of randomized clinical trials against the standard of care, CDTs have limited diffusion and a significant proportion of high-risk and intermediate–high-risk PE patients represent an area of unmet clinical need, with high mortality due to PE consequences if left untreated, and high bleeding risk if treatment is attempted.

In this scenario, there is a growing clinical and scientific interest in CDTs because they could tackle some unresolved issues targeting the treatment of pulmonary arteries and avoiding the dreaded complication of ST.

Several areas in this field need to be further assessed, including the definition of treatment failure or the long-term effect of CDTs.

The aim of this Special Issue is to gather evidence regarding the currently available CDT approaches in PE patients, patient selection, and the timing and techniques of the procedure.

Dr. Filippo Russo
Dr. Mario Iannaccone
Guest Editors

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Keywords

  • pulmonary embolism
  • catheter-directed treatment
  • catheter-directed thrombolysis
  • thrombus aspiration for pulmonary embolism
  • PERT

Published Papers (2 papers)

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11 pages, 1348 KiB  
Article
Ultrasound-Assisted, Catheter-Directed Thrombolysis for Acute Intermediate/High-Risk Pulmonary Embolism: Design of the Multicenter USAT IH-PE Registry and Preliminary Results
by Claudia Colombo, Nicolò Capsoni, Filippo Russo, Mario Iannaccone, Marianna Adamo, Giovanna Viola, Ilaria Emanuela Bossi, Luca Villanova, Chiara Tognola, Camilla Curci, Francesco Morelli, Rossella Guerrieri, Lucia Occhi, Giuliano Chizzola, Antonio Rampoldi, Francesco Musca, Giuseppe De Nittis, Mario Galli, Giacomo Boccuzzi, Daniele Savio, Davide Bernasconi, Luciana D’Angelo, Andrea Garascia, Alaide Chieffo, Matteo Montorfano, Fabrizio Oliva and Alice Saccoadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(2), 619; https://doi.org/10.3390/jcm13020619 - 22 Jan 2024
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Abstract
Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this [...] Read more.
Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this study. The primary endpoint was the incidence of pulmonary hypertension (PH) at follow-up. Secondary endpoints were short- and mid-term changes in the echocardiographic parameters of right ventricle (RV) function, in-hospital and all-cause mortality, and procedure-related bleeding events. Between March 2018 and July 2023, 102 patients were included. The majority were at intermediate–high-risk PE (86%), were mostly female (57%), and had a mean age of 63.7 ± 14.5 years, and 28.4% had active cancer. Echocardiographic follow-up was available for 70 patients, and in only one, the diagnosis of PH was confirmed by right heart catheterization, resulting in an incidence of 1.43% (CI 95%, 0.036–7.7). RV echocardiographic parameters improved both at 24 h and at follow-up. In-hospital mortality was 3.9% (CI 95%, 1.08–9.74), while all-cause mortality was 11% (CI 95%, 5.4–19.2). Only 12% had bleeding complications, of whom 4.9% were BARC ≥ 3. Preliminary results from the USAT IH-PE registry showed a low incidence of PH, improvement in RV function, and a safe profile. Full article
(This article belongs to the Special Issue Pulmonary Embolism: The Era of Catheter-Directed Treatment)
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9 pages, 2412 KiB  
Opinion
Integrating Pharmacomechanical Treatments for Pulmonary Embolism Management within a Hub-and-Spoke System in the Swiss Ticino Region
by Gianluca Guarnieri, Filip David Constantin, Giovanni Pedrazzini, Maria Antonella Ruffino, Daniel Sürder, Roberta Petrino, Enrico Carlo Zucconi, Luca Gabutti, Adam Ogna, Brenno Balestra and Marco Valgimigli
J. Clin. Med. 2024, 13(9), 2457; https://doi.org/10.3390/jcm13092457 - 23 Apr 2024
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Abstract
The Swiss Ticino regional pulmonary embolism response team (PERT) features direct access to various pharmacomechanical PE management options within a hub/spoke system, by integrating evidence, guidelines’ recommendations and personal experiences. This system involves a collaborative management of patients among the hospitals distributed throughout [...] Read more.
The Swiss Ticino regional pulmonary embolism response team (PERT) features direct access to various pharmacomechanical PE management options within a hub/spoke system, by integrating evidence, guidelines’ recommendations and personal experiences. This system involves a collaborative management of patients among the hospitals distributed throughout the region, which refer selected intermediate–high or high PE patients to a second-level hub center, located in Lugano at Cardiocentro Ticino, belonging to the Ente Ospedaliero Cantonale (EOC). The hub provides 24/7 catheterization laboratory activation for catheter-based intervention (CBI), surgical embolectomy and/or a mechanical support system such as extracorporeal membrane oxygenation (ECMO). The hub hosts PE patients after percutaneous or surgical intervention in two intensive care units, one specialized in cardiovascular anesthesiology, to be preferred for patients without relevant comorbidities or with hemodynamic instability and one specialized in post-surgical care, to be preferred for PE patients after trauma or surgery or with relevant comorbidities, such as cancer. From April 2022 to December 2023, a total of 65 patients were referred to the hub for CBI, including ultrasound-assisted catheter-directed thrombolysis (USAT) or large-bore aspiration intervention. No patient received ECMO or underwent surgical embolectomy. Full article
(This article belongs to the Special Issue Pulmonary Embolism: The Era of Catheter-Directed Treatment)
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