30 October 2023

Catheter-directed thrombolysis may be a safer alternative treatment for pulmonary embolism compared to mechanical thrombectomy, according to the results from a large real-world study announced last week.

Dr Peter Monteleone of the University of Texas at Austin, USA, and colleagues compared the safety of two advanced therapies for pulmonary embolism: ultrasound-assisted catheter-directed thrombolysis (USCDT) and mechanical thrombectomy (MT).

Pulmonary embolism is potentially life-threatening, and traditionally treatment is anticoagulant therapy, with surgical intervention in severe cases.

In the new analysis, outcomes on 83,612,413 patients treated at 16 health care systems between 2009 and 2023 were examined. The researchers took a separate look at newer procedures carried out since 2018.

Overall, ultrasound-assisted catheter-directed thrombolysis “emerged as the preferred approach”, the team report in the Journal of the Society for Cardiovascular Angiography & Interventions due to “its lower risk of complications, particularly major bleeding”.

USCDT involves a catheter delivering thrombolytic drugs to blood vessels at the site of the clot, directly into the thrombus, with ultrasound energy used to help break down the clot.

Mechanical thrombectomy was linked to an increased risk of intracranial haemorrhage in the week following. This method uses a device to physically remove the thrombus from the blood vessel.

Therapies all appeared similar in length of stay, readmission and inpatient mortality, but the authors add: “The study highlighted the importance of individual patient characteristics in determining the most suitable treatment modality.”

Findings were also presented last week at TCT 2023, the Cardiovascular Research Foundation’s annual meeting focusing on Transcatheter Cardiovascular Therapeutics. It was held from October 23 to 26 in San Francisco, USA.

Dr Monteleone said: “This study is a significant step forward in our understanding of the treatment options available for pulmonary embolism.”



Monteleone P, Ahern R, Banerjee S, Desai KR, Kadian-Dodov D, Webber E, Omidvar S, Troy P, Parikh SA (2023) “Modern Treatment of Pulmonary Embolism (USCDT Versus MT): Results From a Real-World, Big Data Analysis (REAL-PE).” Journal of the Society for Cardiovascular Angiography & Interventions, doi: 10.1016/j.jscai.2023.101192

Link: https://www.jscai.org/article/S2772-9303(23)01194-8/fulltext   

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