Sign in to use this feature.

Years

Between: -

Subjects

remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline
remove_circle_outline

Journals

Article Types

Countries / Regions

Search Results (41)

Search Parameters:
Keywords = catheter-directed thrombolysis

Order results
Result details
Results per page
Select all
Export citation of selected articles as:
17 pages, 3650 KiB  
Systematic Review
Catheter-Based Therapies in Acute Pulmonary Embolism—Mortality and Safety Outcomes: A Systematic Review and Meta-Analysis
by Panagiotis Zoumpourlis, Shaunak Mangeshkar, Kuan-Yu Chi, Dimitrios Varrias, Michail Spanos, Muhammad Fahimuddin, Matthew D. Langston, Usman A. Khan, Michael J. Grushko, Prabhjot Singh and Seth I. Sokol
J. Clin. Med. 2025, 14(12), 4167; https://doi.org/10.3390/jcm14124167 - 12 Jun 2025
Viewed by 608
Abstract
Background/Objectives: Right ventricular (RV) dysfunction and circulatory collapse are considered to play a major role in mortality in patients suffering from pulmonary embolism (PE). Catheter-based therapies (CBTs) have been shown to improve RV hemodynamics. The aim of this study was to present available [...] Read more.
Background/Objectives: Right ventricular (RV) dysfunction and circulatory collapse are considered to play a major role in mortality in patients suffering from pulmonary embolism (PE). Catheter-based therapies (CBTs) have been shown to improve RV hemodynamics. The aim of this study was to present available data for CBTs in acute PE and investigate whether CBTs offer mortality benefit and better safety outcomes over anticoagulation (AC) in patients with intermediate-risk PE. Methods: PubMed was searched from inception until February 2024 for studies that investigated treatment strategies in patients with confirmed PE. We initially investigated the crude incidence of mortality and major bleeding for individual interventions in patients with either intermediate or high-risk PE. We then directly compared CBT to AC for intermediate-risk PE, for which the effectiveness endpoint was comparative short-term (30-day or in-hospital) and midterm (90-day or 1-year) all-cause mortality and the safety outcomes included minor bleeding, major bleeding, and intracranial hemorrhage (ICH). Results: In all, 59 studies (4457 patients) were eventually included in our study. For the prevalence study, we described the crude incidence for mortality and major bleeding for interventions like catheter-directed thrombolysis (CDT), mechanical thrombectomy (MT), AC, and systemic thrombolysis (ST) in patients with either intermediate or high-risk PE. Our data synthesis comparing CBT to AC included 1657 patients (11 studies) with intermediate-risk PE. Our results indicate that CBT is associated with a lower risk of both short-term (RR 0.43; 95% CI [0.24–0.79], I2 = 0%) and midterm all-cause mortality (RR 0.38; 95% CI [0.23–0.62], I2 = 0%) compared to AC. Major bleeding and ICH did not differ between the two groups. Conclusions: In patients with intermediate-risk PE, our meta-analysis of the current literature suggests that CBT offers better outcomes in terms of short-term and midterm mortality compared to AC alone, with no difference in safety outcomes. Further RCTs are needed to explore and validate these findings. Full article
(This article belongs to the Section Cardiovascular Medicine)
Show Figures

Figure 1

10 pages, 515 KiB  
Article
Catheter-Directed Thrombolysis vs. Anticoagulation in Deep Vein Thrombosis: A Comparative Study
by Mehmet Cahit Saricaoglu, Ali Ihsan Hasde, Ali Fuat Karacuha, Ahmet Kayan, Onur Buyukcakır, Fatma Akca, Evren Ozcinar, Cagdas Baran, Mustafa Bahadir Inan, Mustafa Sirlak, Levent Yazicioglu, Ahmet Ruchan Akar and Sadik Eryilmaz
J. Clin. Med. 2025, 14(10), 3298; https://doi.org/10.3390/jcm14103298 - 9 May 2025
Viewed by 900
Abstract
Background: Deep vein thrombosis (DVT) is an important component of venous thromboembolism and can lead to pulmonary embolism with high morbidity and mortality. Anticoagulant therapy alone (AC) and catheter-directed thrombolysis (CDT) are commonly used strategies for the management of DVT. Although CDT has [...] Read more.
Background: Deep vein thrombosis (DVT) is an important component of venous thromboembolism and can lead to pulmonary embolism with high morbidity and mortality. Anticoagulant therapy alone (AC) and catheter-directed thrombolysis (CDT) are commonly used strategies for the management of DVT. Although CDT has been reported to be effective in reducing the risk of post-thrombotic syndrome (PTS), it remains unclear in which patient groups it should be preferred due to the risk of bleeding. Methods: This retrospective study included 175 patients diagnosed with DVT between 2015 and 2024 (98 AC, 77 CDT). Patients with a diagnosis of proximal DVT, aged ≥18 years, and with at least 30 days of follow-up data were included. The primary endpoint was 30-day mortality and secondary endpoints were the length of hospitalization, pulmonary embolism, and bleeding complications. Results: The CDT group was superior to AC in thrombus clearance rates, especially in iliac vein thrombosis (97.7% vs. 78%, p = 0.003). Clinical symptoms improved faster in the CDT group, but total hospitalization was longer. There were no significant differences in bleeding complications and mortality rates between the two groups. Conclusions: The optimal approach to DVT treatment should be based on the patient’s individual risk factors. Although CDT provides a higher thrombus clearance rate, especially in iliac vein thrombosis, it may not be suitable for all patients. Future large-scale studies will contribute to a better understanding of the long-term outcomes of interventional therapies. Full article
(This article belongs to the Section Cardiovascular Medicine)
Show Figures

Figure 1

18 pages, 1406 KiB  
Systematic Review
Treatment Strategies and Prognostic Outcomes in Acute Limb Ischemia: A Systematic Review and Meta-Analysis Comparing Thrombolytic Therapy and Open Surgical Interventions
by Mircea Cătălin Coșarcă, Nicolae Alexandru Lazăr, Suzana Vasilica Șincaru, Bogdan Corneliu Bandici, Eduard Costin Argatu, Cosmin Carașca, Ráduly Gergő, Dorin Constantin Dorobanțu, Cristian Trâmbițaș and Adrian Vasile Mureșan
Medicina 2025, 61(5), 828; https://doi.org/10.3390/medicina61050828 - 30 Apr 2025
Viewed by 946
Abstract
Background and Objectives: Acute limb ischemia (ALI) is a life-threatening vascular emergency that requires immediate intervention to restore perfusion and prevent limb loss or mortality. Management strategies primarily include thrombolysis and surgical revascularization, each with distinct risks and benefits. This review evaluates [...] Read more.
Background and Objectives: Acute limb ischemia (ALI) is a life-threatening vascular emergency that requires immediate intervention to restore perfusion and prevent limb loss or mortality. Management strategies primarily include thrombolysis and surgical revascularization, each with distinct risks and benefits. This review evaluates and compares the outcomes of thrombolysis and surgical revascularization in ALI management, emphasizing their efficacy, safety, and patient selection criteria. Materials and Methods: A systematic review was conducted in adherence to PRISMA guidelines, analyzing data from 15 studies, including randomized controlled trials and large retrospective analyses, encompassing over 3500 patients with varying demographics and clinical presentations. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle–Ottawa Scale. Results: Thrombolysis, utilizing agents such as urokinase or recombinant tissue plasminogen activator (rt-PA), demonstrated limb salvage rates up to 90% in acute cases, with 30-day mortality rates of 4–6%. It was particularly effective in patients with embolic occlusions or short symptom durations. However, bleeding complications associated with thrombolysis were reported in up to 47% of cases. Conversely, surgical revascularization remains crucial for those with advanced ischemia or contraindications to thrombolysis, offering reliable perfusion restoration but with higher perioperative morbidity, especially in older patients with significant comorbidities. Recent advancements, including hybrid approaches combining catheter-directed thrombolysis with percutaneous mechanical thrombectomy, have shown promise in improving outcomes by reducing procedure times and enhancing clot resolution. Conclusions: While thrombolysis and surgical revascularization are effective, optimizing patient selection remains a key challenge. Future research should focus on refining treatment algorithms, investigating novel thrombolytic agents, and expanding the role of minimally invasive techniques to improve long-term outcomes while mitigating complications such as bleeding and reperfusion injuries. Full article
(This article belongs to the Section Surgery)
Show Figures

Figure 1

10 pages, 1218 KiB  
Article
Comparison of 30-Day Readmission Between Early and Late Catheter Directed Thrombolysis for Acute Pulmonary Embolism in the United States
by Kwabena Sefah Nketiah Sarpong, Sun-Joo Jang, Mary Quien, Karthik Muralidharan, Abhinav Aggarwal, Ilhwan Yeo and Kavitha Gopalratnam
J. Cardiovasc. Dev. Dis. 2025, 12(4), 118; https://doi.org/10.3390/jcdd12040118 - 27 Mar 2025
Viewed by 480
Abstract
Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5–10% of in-hospital deaths. There is sparse comparative data on readmission patterns in patients who undergo early versus late catheter [...] Read more.
Background: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5–10% of in-hospital deaths. There is sparse comparative data on readmission patterns in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE. Research Question: Is the procedure day for acute PE associated with a difference in 30-day readmission rates? Study Design and Method: This study was performed by using the Nationwide Readmissions Database between 2016 and 2019. Patients with acute PE who underwent CDT were identified using codes from the International Classification of Diseases, 10th Edition (ICD 10). Results: The 30-day readmission rates were higher for patients who underwent CDT on Day 2 or afterwards compared to Day 1 and Day 0 (7.1% vs. 5.7% vs. 5.2%). Patients who had CDT on Day 2 or later had a higher rate of 30-day readmission mortality compared to those who had CDT on Day 1 or 0 (0.6% vs. 0.3% vs. 0.2%. The 30-day readmission rates for heart failure were higher among patients who had CDT on Day 2 compared to those who had CDT on Day 0 of admission (2% vs. 1.0% vs. 0.9%). Interpretation: Delayed CDT for acute PE was associated with increased rates of 30-day readmission, readmission mortality, and readmission for heart failure. These findings emphasize the need for earlier CDT for the treatment of acute PE. Full article
Show Figures

Figure 1

8 pages, 332 KiB  
Review
Mechanical Thrombectomy for Acute Pulmonary Embolism in Non-Operating Room Anesthesia (NORA) Locations: Best Safety Practices and Local Insights
by Omar Elmadhoun, Jeffrey Huang, Arnoley S. Abcejo and Michael P. Merren
Healthcare 2025, 13(3), 227; https://doi.org/10.3390/healthcare13030227 - 23 Jan 2025
Cited by 1 | Viewed by 1458
Abstract
Mortality rates from pulmonary embolism (PE) remain significant, highlighting the need for alternative treatment strategies beyond traditional anticoagulation. Percutaneous interventions, including mechanical thrombectomy and catheter-directed thrombolysis, are emerging as promising options. Given the complex pathophysiology and unique risk profiles of these patients, meticulous [...] Read more.
Mortality rates from pulmonary embolism (PE) remain significant, highlighting the need for alternative treatment strategies beyond traditional anticoagulation. Percutaneous interventions, including mechanical thrombectomy and catheter-directed thrombolysis, are emerging as promising options. Given the complex pathophysiology and unique risk profiles of these patients, meticulous multidisciplinary planning is essential. Anesthesiologists play a central role in coordinating care and managing perioperative risks to improve outcomes. This article provides insights into best safety practices and shares experiences from a leading quaternary center. It offers guidance for anesthesia providers to proactively engage in comprehensive risk stratification, participate in multidisciplinary discussions, and support robust contingency planning for managing PE patients undergoing percutaneous interventions in non-operating room anesthesia settings. Full article
Show Figures

Figure 1

22 pages, 2597 KiB  
Review
A Comprehensive Review of Catheter-Related Thrombosis
by Marina López-Rubio, Marta-Olimpia Lago-Rodríguez, Lucía Ordieres-Ortega, Crhistian-Mario Oblitas, Sergio Moragón-Ledesma, Rubén Alonso-Beato, Luis-Antonio Alvarez-Sala-Walther and Francisco Galeano-Valle
J. Clin. Med. 2024, 13(24), 7818; https://doi.org/10.3390/jcm13247818 - 21 Dec 2024
Cited by 1 | Viewed by 7579
Abstract
Catheter-related thrombosis (CRT) is a frequent and potentially serious complication associated with the widespread use of intravascular devices such as central venous catheters, including peripherally inserted central catheters and implantable port systems, pacemakers or implantable cardioverter-defibrillators. Although CRT management has been informed by [...] Read more.
Catheter-related thrombosis (CRT) is a frequent and potentially serious complication associated with the widespread use of intravascular devices such as central venous catheters, including peripherally inserted central catheters and implantable port systems, pacemakers or implantable cardioverter-defibrillators. Although CRT management has been informed by guidelines extrapolated from lower extremity deep vein thrombosis (DVT), unique challenges remain due to the distinct anatomical, pathophysiological, and clinical characteristics of upper extremity DVT. Risk factors for CRT are multifactorial, encompassing patient-related characteristics such as cancer, prior venous thromboembolism, and infection, as well as catheter-specific factors like device type, lumens, and insertion site. The diagnosis of CRT relies primarily on ultrasonography; however, computed tomography angiography and magnetic resonance imaging play a complementary role, particularly in anatomically challenging cases or when complications such as pulmonary embolism or superior vena cava syndrome are suspected. Treatment strategies for CRT include anticoagulation, catheter removal when feasible, and, in select cases, local thrombolysis or catheter-directed interventions. Anticoagulation remains the cornerstone of therapy, with direct oral anticoagulants increasingly favored due to their safety profile and efficacy. This article provides a detailed review of CRT, focusing on clinical features, diagnostic methods, and treatment strategies while addressing specific challenges in managing pacemaker and hemodialysis catheter-related thrombosis. Full article
Show Figures

Figure 1

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 1833
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)
Show Figures

Figure 1

30 pages, 1605 KiB  
Review
A Practical Clinical Approach to Navigate Pulmonary Embolism Management: A Primer and Narrative Review of the Evolving Landscape
by Kevin Benavente, Bradley Fujiuchi, Hafeez Ul Hassan Virk, Pavan K. Kavali, Walter Ageno, Geoffrey D. Barnes, Marc Righini, Mahboob Alam, Rachel P. Rosovsky and Chayakrit Krittanawong
J. Clin. Med. 2024, 13(24), 7637; https://doi.org/10.3390/jcm13247637 - 15 Dec 2024
Viewed by 2780
Abstract
Advances in imaging, pharmacological, and procedural technologies have rapidly expanded the care of pulmonary embolism. Earlier, more accurate identification and quantification has enhanced risk stratification across the spectrum of the disease process, with a number of clinical tools available to prognosticate outcomes and [...] Read more.
Advances in imaging, pharmacological, and procedural technologies have rapidly expanded the care of pulmonary embolism. Earlier, more accurate identification and quantification has enhanced risk stratification across the spectrum of the disease process, with a number of clinical tools available to prognosticate outcomes and guide treatment. Direct oral anticoagulants have enabled a consistent and more convenient long-term therapeutic option, with a greater shift toward outpatient treatment for a select group of low-risk patients. The array of catheter-directed therapies now available has contributed to a more versatile and nuanced armamentarium of treatment options, including ultrasound-facilitated thrombolysis and mechanical thrombectomy. Research into supportive care for pulmonary embolism have explored the optimal use of vasopressors and volume resuscitation, as well as utilization of various devices, including right ventricular mechanical support and extracorporeal membrane oxygenation. Even in the realm of surgery, outcomes have steadily improved in experienced centers. This rapid expansion in diagnostic and therapeutic data has necessitated implementation of pulmonary embolism response teams to better interpret the available evidence, manage the utilization of advanced therapies, and coordinate multidisciplinary care. We provide a narrative review of the risk stratification and management of pulmonary embolism, with a focus on structuralizing the multidisciplinary approach and organizing the literature on new and emerging therapies. Full article
Show Figures

Figure 1

16 pages, 2723 KiB  
Systematic Review
Pulmonary Embolism Response Teams—Evidence of Benefits? A Systematic Review and Meta-Analysis
by Amelia Bryan, Quincy K. Tran, Jalil Ahari, Erin Mclaughlin, Kirsten Boone and Ali Pourmand
J. Clin. Med. 2024, 13(24), 7623; https://doi.org/10.3390/jcm13247623 - 14 Dec 2024
Viewed by 1498
Abstract
Background: Venous thromboembolisms constitute a major cause of morbidity and mortality with 60,000 to 100,000 deaths attributed to pulmonary embolism in the US annually. Both clinical presentations and treatment strategies can vary greatly, and the selection of an appropriate therapeutic strategy is often [...] Read more.
Background: Venous thromboembolisms constitute a major cause of morbidity and mortality with 60,000 to 100,000 deaths attributed to pulmonary embolism in the US annually. Both clinical presentations and treatment strategies can vary greatly, and the selection of an appropriate therapeutic strategy is often provider specific. A pulmonary embolism response team (PERT) offers a multidisciplinary approach to clinical decision making and the management of high-risk pulmonary emboli. There is insufficient data on the effect of PERT programs on clinical outcomes. Methods: We searched PubMed, Scopus, Web of Science, and Cochrane to identify PERT studies through March 2024. The primary outcome was all-cause mortality, and the secondary outcomes included the rates of surgical thrombectomy, catheter directed thrombolysis, hospital length of stay (HLOS), and ICU length of stay (ICULOS). We used the Newcastle−Ottawa Scale tool to assess studies’ quality. We used random-effects models to compare outcomes between the pooled populations and moderator analysis to identify sources of heterogeneity and perform subgroup analysis. Results: We included 13 observational studies, which comprised a total of 12,586 patients, 7512 (60%) patients were from the pre-PERT period and 5065 (40%) patients were from the PERT period. Twelve studies reported the rate of all-cause mortality for their patient population. Patients in the PERT period were associated with similar odds of all-cause mortality as patients in the pre-PERT period (OR: 1.52; 95% CI: 0.80–2.89; p = 0.20). In the random-effects meta-analysis, there was no significant difference in ICULOS between PERT and pre-PERT patients (difference in means: 0.08; 95% CI: −0.32 to 0.49; p = 0.68). There was no statistically significant difference in HLOS between the two groups (difference in means: −0.82; 95% CI: −2.86 to 1.23; p = 0.43). Conclusions: This meta-analysis demonstrates no significant difference in all studied measures in the pre- and post-PERT time periods, which notably included patient mortality and length of stay. Further study into the details of the PERT system at institutions reporting mortality benefits may reveal practice differences that explain the outcome discrepancy and could help optimize PERT implementation at other institutions. Full article
Show Figures

Figure 1

10 pages, 871 KiB  
Article
Catheter-Directed Arterial Thrombolysis with a Low-Dose Recombinant Tissue Plasminogen Activator Regimen for Acute Lower Limb Ischemia—Results of the First Regional Registry of Acute Limb Ischemia in Romania
by Sorin Barac, Roxana Ramona Onofrei, Octavian Barbu, Stelian Pantea, Cristina Pleșoianu, Ciprian Gîndac, Bogdan Timar and Andreea Luciana Rață
Life 2024, 14(11), 1516; https://doi.org/10.3390/life14111516 - 20 Nov 2024
Viewed by 1247
Abstract
Acute limb ischemia is a limb-threatening condition that is associated with a high degree of mortality and morbidity, with the latter related to acute kidney injury and rhabdomyolysis that can rapidly lead to multiple organ failure. The aim of this study was to [...] Read more.
Acute limb ischemia is a limb-threatening condition that is associated with a high degree of mortality and morbidity, with the latter related to acute kidney injury and rhabdomyolysis that can rapidly lead to multiple organ failure. The aim of this study was to assess the efficacy and safety of catheter-directed arterial thrombolysis in acute lower limb ischemia in the Department of Vascular Surgery, Timișoara, Romania. A total of 158 patients (114 males—72.15% and 44 females—27.85%) with symptoms of acute lower limb ischemia were admitted and treated with catheter-directed arterial thrombolysis following our protocol. The amputation-free survival rate at 1 month after the thrombolysis was 82.3%, and at 6 months it was 77.85%. The performance of additional procedures to obtain distal perfusion was predictive of an improved outcome at 30 days. The estimated survival rate at 6 months was 84.81% (SE 0.02). The mean survival time was 158.74 days. We recommend the usage of a thrombolytic regimen in patients with a life expectancy of more than 6 months, even in Rutherford stage IIb patients, if there is no major impairment in the sensorial and mobility function of the ischemic leg. Full article
Show Figures

Figure 1

13 pages, 388 KiB  
Article
Catheter-Directed Thrombolysis in the Management of Thrombotic Peripheral Artery Occlusions—Acute and Mid-Term Clinical Outcomes
by Ulrich Beschorner, Tanja Boehme, Elias Noory, Roaa Bollenbacher, Jonas Salm, Kambis Mashayekhi, Dirk Westermann and Thomas Zeller
J. Clin. Med. 2024, 13(19), 5732; https://doi.org/10.3390/jcm13195732 - 26 Sep 2024
Cited by 1 | Viewed by 1489
Abstract
Objectives: To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) with the recombinant tissue plasminogen activator (rt-PA) in all patients with symptomatic peripheral artery disease in real world practice. Methods: Consecutive patients treated with CDT between January 2013 and December 2020 [...] Read more.
Objectives: To evaluate the safety and efficacy of catheter-directed thrombolysis (CDT) with the recombinant tissue plasminogen activator (rt-PA) in all patients with symptomatic peripheral artery disease in real world practice. Methods: Consecutive patients treated with CDT between January 2013 and December 2020 were included in this retrospective analysis. The primary endpoint was the rate of serious adverse events (SAEs) until discharge. Secondary endpoints included interventional success, predictors for SAEs, bleeding and reperfusion edema/compartment syndrome, limb salvage, and clinical outcomes including target lesion revascularization rate (TLR). Results: Overall, 1238 patients were treated with CDT. SAEs occurred in 511 (41.3%) of the patients, 314 (25.4%) being bleeding complications. There were 95 cases of reperfusion edema/compartment syndrome. Forty-two patients underwent amputation and 33 patients (2.7%) died. CDT was successful in 1177 cases (95.1%). Multivariate logistic regression analysis identified age, abciximab and alprostadil usage, and lysis duration as predictors for SAEs and the use of abciximab as a predictor of reperfusion edema/compartment syndrome. Predictors for bleeding were age, alprostadil usage, and lysis duration. At 12 and 24 months, the limb salvage rate was 91.6% and 88.8%, and TLR rate was 46% and 57.2%, respectively. Conclusions: CDT is an effective endovascular method for the treatment of thrombotic peripheral artery occlusions but is associated with a high complication rate. For SAEs in general and bleeding specifically, increasing age, alprostadil use, and lysis duration were independent risk factors. Full article
(This article belongs to the Section Vascular Medicine)
Show Figures

Graphical abstract

13 pages, 561 KiB  
Review
Risk Stratification and Management of Intermediate- and High-Risk Pulmonary Embolism
by Sanaullah Mojaddedi, Javairia Jamil, Daniel Bishev, Kobina Essilfie-Quaye and Islam Y. Elgendy
J. Clin. Med. 2024, 13(18), 5583; https://doi.org/10.3390/jcm13185583 - 20 Sep 2024
Cited by 2 | Viewed by 4984
Abstract
Acute pulmonary embolism (PE) is a leading cause of mortality. Not only is PE associated with short-term mortality, but up to ~20% of patients might suffer from long-term consequences such as post-PE syndrome and chronic thromboembolic pulmonary hypertension. Current risk stratification tools poorly [...] Read more.
Acute pulmonary embolism (PE) is a leading cause of mortality. Not only is PE associated with short-term mortality, but up to ~20% of patients might suffer from long-term consequences such as post-PE syndrome and chronic thromboembolic pulmonary hypertension. Current risk stratification tools poorly predict those who are at risk for short-term deterioration and those who develop long-term consequences. Traditionally, systemic thrombolysis has been considered the first-line therapy for patients with high-risk PE without contraindications; however, it comes with the risk of major bleeding (notably intracranial hemorrhage). The use of catheter-directed interventions (embolectomy or thrombolysis) has been increasing owing to their low bleeding risk; however, randomized trial data supporting their efficacy in improving clinical outcomes are limited. In this review, we highlight the evidence supporting the available advanced therapies for high- and intermediate-risk PE and summarize the ongoing trials which are evaluating these therapies. Full article
(This article belongs to the Section Cardiology)
Show Figures

Figure 1

16 pages, 287 KiB  
Review
Novel Challenges and Therapeutic Options for Pulmonary Embolism and Deep Vein Thrombosis
by Chiara Cavallino, Marco Franzino, Mohamed Abdirashid, Ludovica Maltese, Elodi Bacci, Francesco Rametta and Fabrizio Ugo
J. Pers. Med. 2024, 14(8), 885; https://doi.org/10.3390/jpm14080885 - 21 Aug 2024
Cited by 2 | Viewed by 3130
Abstract
Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment [...] Read more.
Acute pulmonary embolism (PE), often resulting from deep vein thrombosis (DVT), is the third most frequent cause of cardiovascular death and is associated with increasing incidence, causing considerable morbidity and mortality. This review aims to evaluate the efficacy, safety, and outcomes of treatment options in the management of acute PE and DVT, encompassing both established and emerging technologies, such as catheter-directed thrombolysis, aspiration thrombectomy, and other endovascular techniques. A comprehensive literature review was conducted, assessing clinical studies, trials, and case reports that detail the use of percutaneous interventions for PE and DVT and analyzing the advantages and disadvantages of each percutaneous system. Several percutaneous treatments have shown promising results, especially in cases where rapid thrombus resolution is critical, such as in high- and intermediate–high-risk patients. The incidence of major complications, such as bleeding, remains a consideration, though it is generally manageable with proper patient selection and technique. It is fundamentally important to tailor the specific treatment strategy to the clinical and anatomical characteristics of each patient. Percutaneous treatments for acute PE and DVT represent valuable options in the therapeutic arsenal, offering enhanced outcomes in appropriately selected patients. Ongoing advancements in technology and technique, along with comprehensive clinical trials, are essential to further define the role and optimize the use of these interventions. Full article
(This article belongs to the Section Clinical Medicine, Cell, and Organism Physiology)
2 pages, 139 KiB  
Correction
Correction: Alhuarrat et al. Comparison of In-Hospital Outcomes between Early and Late Catheter-Directed Thrombolysis in Acute Pulmonary Embolism: A Retrospective Observational Study. J. Clin. Med. 2024, 13, 1093
by Majd Al Deen Alhuarrat, Kirolos Barssoum, Medhat Chowdhury, Sheetal Vasundara Mathai, Miriam Helft, Michael Grushko, Prabhjot Singh, Hani Jneid, Afaq Motiwala, Robert T. Faillace and Seth I. Sokol
J. Clin. Med. 2024, 13(15), 4502; https://doi.org/10.3390/jcm13154502 - 1 Aug 2024
Cited by 1 | Viewed by 997
Abstract
Text correction explained [...] Full article
(This article belongs to the Section Cardiovascular Medicine)
9 pages, 1281 KiB  
Article
Clinical Outcome Using Different Catheter Interventional Treatment Modalities in High-Risk Pulmonary Artery Embolism
by Luise Antonia Mentzel, Parham Shahidi, Stephan Blazek, Dmitry Sulimov, Holger Thiele and Karl Fengler
J. Cardiovasc. Dev. Dis. 2024, 11(7), 228; https://doi.org/10.3390/jcdd11070228 - 22 Jul 2024
Cited by 1 | Viewed by 1385
Abstract
Background: For patients with high-risk pulmonary artery embolism (PE), catheter-directed therapies pose a viable alternative treatment option to systemic thrombolysis or anticoagulation. Right now, there are multiple devices available which have been proven to be safe and effective in lower-risk settings. There is, [...] Read more.
Background: For patients with high-risk pulmonary artery embolism (PE), catheter-directed therapies pose a viable alternative treatment option to systemic thrombolysis or anticoagulation. Right now, there are multiple devices available which have been proven to be safe and effective in lower-risk settings. There is, however, little data comparing their efficacies in high-risk PE. Methods: We performed a retrospective, single-center study on patients with high-risk PE undergoing catheter interventional treatment. Patients receiving large-bore catheter thrombectomy were compared to patients receiving alternative treatment forms. Results: Of the 20 patients included, 9 received large-bore thrombectomy, and 11 received alternative interventional treatments. While the baseline characteristics were comparable between the two groups, periprocedural and in-hospital mortality tended to be significantly lower with large-bore thrombectomy when compared to other treatment forms (0 vs. 55% and 33 vs. 82%, p = 0.07 and 0.01, respectively). Conclusions: In this small, retrospective study, large-bore thrombectomy was associated with lower mortality as compared to alternative treatment forms. Future prospective research is needed to corroborate these findings. Full article
(This article belongs to the Section Cardiovascular Clinical Research)
Show Figures

Figure 1

Back to TopTop