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Pulmonary Embolism: The Era of Catheter-Directed Treatment
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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 "Respiratory Medicine".

Deadline for manuscript submissions: closed (24 May 2024) | Viewed by 10354

Special Issue Editors

Dr. Filippo Russo

E-Mail Website
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
Dr. Mario Iannaccone

E-Mail Website
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
Special Issues, Collections and Topics in MDPI journals

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

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Published Papers (4 papers)

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Research

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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
Cited by 2 | Viewed by 2124
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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Review

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17 pages, 953 KiB  
Review
Advanced Management of Patients Undergoing Transcatheter Treatment for Pulmonary Embolism: Evidence-Based Strategies for Optimized Patient Care
by Francesco Costa, Alfonso Jurado-Román, Gabriele Carciotto, Victor Becerra-Munoz, Daniel Tébar Márquez, Felix Götzinger, Enrico Cerrato, Shantum Misra, Marco Spissu, Marco Pavani, Marco Mennuni, Fernando Carrasco Chinchilla, Antonio Dominguez-Franco, Antonio Muñoz-Garcia, Rocio Sanchez Navarrete, Ferdinando Varbella, Pablo Salinas-Sanguino, Eric A. Secemsky, Felix Mahfoud, Antonio Micari, Juan Horacio Alonso-Briales and Manuel Jimenez Navarroadd Show full author list remove Hide full author list
J. Clin. Med. 2024, 13(24), 7780; https://doi.org/10.3390/jcm13247780 - 20 Dec 2024
Viewed by 1351
Abstract
Pulmonary embolism (PE) is a life-threatening medical condition caused by the thrombotic occlusion of one or more branches of the lung vasculature, which represents the third most common cause of cardiovascular mortality after myocardial infarction and stroke. PE treatment requires a tailored approach [...] Read more.
Pulmonary embolism (PE) is a life-threatening medical condition caused by the thrombotic occlusion of one or more branches of the lung vasculature, which represents the third most common cause of cardiovascular mortality after myocardial infarction and stroke. PE treatment requires a tailored approach based on accurate risk stratification and personalized treatment decision-making. Anticoagulation is the cornerstone of PE management, yet patients at higher clinical risk may require more rapid reperfusion therapies. In recent years, transcatheter treatment has emerged as a valuable option for patients with intermediate–high or high-risk PE who have contraindications to systemic thrombolysis. Recent advancements in catheter-directed therapies, such as catheter-directed thrombolysis (CDT) and catheter-directed mechanical thrombectomy (CDMT), provide minimally invasive options for swift symptom relief and hemodynamic stabilization. This review aims to provide a practical approach for optimal patient selection and management for PE percutaneous therapies, supported by a thorough evaluation of the current evidence base supporting these procedures. A focus on post-procedural management, the prevention of recurrence, and monitoring for long-term complications such as chronic pulmonary hypertension and post-PE syndrome is also specifically tackled. Full article
(This article belongs to the Special Issue Pulmonary Embolism: The Era of Catheter-Directed Treatment)
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15 pages, 6943 KiB  
Review
Mechanical Circulatory Support Devices in Patients with High-Risk Pulmonary Embolism
by Rama Ellauzi, Saliha Erdem, Mohammad Fahad Salam, Ashish Kumar, Vikas Aggarwal, Gerald Koenig, Herbert D. Aronow and Mir Babar Basir
J. Clin. Med. 2024, 13(11), 3161; https://doi.org/10.3390/jcm13113161 - 28 May 2024
Viewed by 5015
Abstract
Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients with high-risk and massive pulmonary embolisms. In particular, we focus on the role of mechanical circulatory support devices and their possible [...] Read more.
Pulmonary embolism (PE) is a common acute cardiovascular condition. Within this review, we discuss the incidence, pathophysiology, and treatment options for patients with high-risk and massive pulmonary embolisms. In particular, we focus on the role of mechanical circulatory support devices and their possible therapeutic benefits in patients who are unresponsive to standard therapeutic options. Moreover, attention is given to device selection criteria, weaning protocols, and complication mitigation strategies. Finally, we underscore the necessity for more comprehensive studies to corroborate the benefits and safety of MCS devices in PE management. Full article
(This article belongs to the Special Issue Pulmonary Embolism: The Era of Catheter-Directed Treatment)
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Other

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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
Viewed by 1048
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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