First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes
Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic...
Saved in:
| Published in: | Journal of thrombosis and thrombolysis 2023-05, Vol.55 (4), p.660-666 |
|---|---|
| Main Authors: | , , , , , , , |
| Format: | Article |
| Language: | eng |
| Subjects: | |
| Online Access: | Get full text |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| recordid |
cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10073780 |
|---|---|
| title |
First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes |
| format |
Article |
| creator |
Kojodjojo, Pipin Ong, Hean Ann Loh, Poay Huan Tay, Edgar Chang, Peter Kuntjoro, Ivandito Low, Ting Ting Lim, Yinghao |
| subjects |
Acute Disease Adult Aged Cardiology Clinical outcomes Clinical trials Embolism Feasibility Studies Female Fibrinolytic Agents Heart Hematology Humans Male Medicine Medicine & Public Health Middle Aged Pulmonary Embolism - surgery Pulmonary embolisms Reperfusion Suction - methods Suctioning Thrombectomy - methods Thrombolysis Thrombolytic Therapy - methods Thrombosis Treatment Outcome Venous Thromboembolism - etiology Ventricle |
| ispartof |
Journal of thrombosis and thrombolysis, 2023-05, Vol.55 (4), p.660-666 |
| description |
Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE. Thus, a huge clinical need exists for an effective technique to restore pulmonary perfusion with minimal risk and avoidance of lytic therapy. In 2021, large bore suction thrombectomy (ST) was introduced in Asia for the first time and this study assessed the feasibility and short-term outcomes of Asian patients undergoing ST for acute PE. 40 consecutive patients (58% male, mean age of 58.3 ± 16.6 years) with intermediate (87.5%) or high-risk PE (12.5%) were enrolled in this prospective registry. 20% had prior VTE, 42.5% had contraindications to thrombolysis, and 10% failed to respond to thrombolysis. PE was idiopathic in 40%, associated with active cancer in 15% and post-operative status in 12.5%. Procedural time was 124 ± 30 min. Emboli were aspirated in all patients without the need for thrombolytics, resulting in a 21.4% reduction in mean pulmonary arterial pressures and 123% increase TASPE-PASP ratio, a prognostic measure of RV-arterial coupling. (both p |
| language |
eng |
| source |
Springer Online Journals |
| identifier |
ISSN: 1573-742X |
| fulltext |
fulltext |
| issn |
1573-742X 0929-5305 1573-742X |
| url |
http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-05-25T07%3A04%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=First%20use%20of%20large-bore%20suction%20thrombectomy%20for%20acute%20pulmonary%20embolism%20in%20Asia-Pacific:%20feasibility%20and%20short-term%20clinical%20outcomes&rft.jtitle=Journal%20of%20thrombosis%20and%20thrombolysis&rft.au=Kojodjojo,%20Pipin&rft.date=2023-05-01&rft.volume=55&rft.issue=4&rft.spage=660&rft.epage=666&rft.pages=660-666&rft.issn=1573-742X&rft.eissn=1573-742X&rft_id=info:doi/10.1007/s11239-023-02802-0&rft_dat=%3Cproquest_pubme%3E2796161222%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c475t-d77b28669fb869e41b3737f71af83896fd6d3054f1471af9db1ff503086ddab3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2807238140&rft_id=info:pmid/37017871 |
| container_title |
Journal of thrombosis and thrombolysis |
| container_volume |
55 |
| container_issue |
4 |
| container_start_page |
660 |
| container_end_page |
666 |
| fullrecord |
<record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10073780</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2796161222</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-d77b28669fb869e41b3737f71af83896fd6d3054f1471af9db1ff503086ddab3</originalsourceid><addsrcrecordid>eNp9kU1vVCEUhonR2Fr9Ay4MiRs3t_Jx58J1Y5rGWpMmuujCHQEuzNDwMfLRZH6Bf1umU2t14YJAOM95Dy8vAK8xOsUIsfcFY0LnARHaF0dkQE_AMV4xOrCRfH_66HwEXpRygxCaZ0SegyPKEGac4WPw88LlUmErBiYLvcxrM6iUDSxNV5cirJucgjK6prCDNmUodasGbpsPKcq8gyao5F0J0EV4VpwcvkntrNMfoDWyOOW8qzso4wLLJuU6VJMD1N5Fp6WHqVWdgikvwTMrfTGv7vcTcH3x6fr8crj6-vnL-dnVoEe2qsPCmCJ8mmar-DSbESvKKLMMS8spnye7TAtFq9HicX83Lwpbu0IU8WlZpKIn4ONBdttUMIs2sWbpxTa70L2IJJ34uxLdRqzTrdh_OGUcdYV39wo5_WimVBFc0cZ7GU1qRRA2T3jChJCOvv0HvUktx25P9LgYoRyPe0FyoHROpWRjH16D0d1YcchZ9JzFXc5i3_TmsY-Hlt_BdoAegNJLcW3yn9n_kf0Fa_e2dw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><isCDI>true</isCDI><recordtype>article</recordtype><pqid>2807238140</pqid></control><display><type>article</type><title>First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes</title><source>Springer Online Journals</source><creator>Kojodjojo, Pipin ; Ong, Hean Ann ; Loh, Poay Huan ; Tay, Edgar ; Chang, Peter ; Kuntjoro, Ivandito ; Low, Ting Ting ; Lim, Yinghao</creator><creatorcontrib>Kojodjojo, Pipin ; Ong, Hean Ann ; Loh, Poay Huan ; Tay, Edgar ; Chang, Peter ; Kuntjoro, Ivandito ; Low, Ting Ting ; Lim, Yinghao</creatorcontrib><description>Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE. Thus, a huge clinical need exists for an effective technique to restore pulmonary perfusion with minimal risk and avoidance of lytic therapy. In 2021, large bore suction thrombectomy (ST) was introduced in Asia for the first time and this study assessed the feasibility and short-term outcomes of Asian patients undergoing ST for acute PE. 40 consecutive patients (58% male, mean age of 58.3 ± 16.6 years) with intermediate (87.5%) or high-risk PE (12.5%) were enrolled in this prospective registry. 20% had prior VTE, 42.5% had contraindications to thrombolysis, and 10% failed to respond to thrombolysis. PE was idiopathic in 40%, associated with active cancer in 15% and post-operative status in 12.5%. Procedural time was 124 ± 30 min. Emboli were aspirated in all patients without the need for thrombolytics, resulting in a 21.4% reduction in mean pulmonary arterial pressures and 123% increase TASPE-PASP ratio, a prognostic measure of RV-arterial coupling. (both p < 0.001) Procedural complications were 5% and 87.5% patients survived to discharge without symptomatic VTE recurrence during 184 days of mean follow-up. ST affords an effective reperfusion option for PE without thrombolytics, normalises RV overload and provides excellent short-term clinical outcomes.
Key points
Large bore suction thrombectomy is an effective minimally invasive reperfusion therapy for patients with intermediate or high-risk pulmonary embolism (PE), without the use of thrombolytics.
Significant reductions in mean pulmonary arterial pressures and heart rates were achieved, resulting in normalisation of right ventricular (RV) strain, size and improvement in RV-pulmonary arterial coupling and stroke volumes.
95% of PE patients who did not require cardiopulmonary resuscitation, survived to discharge without VTE recurrence during 184 days of mean follow-up.
Ongoing multi-centre randomized controlled trials comparing suction thrombectomy to routine care will confirm the benefits of early catheter-based reperfusion therapy for PE.</description><identifier>ISSN: 1573-742X</identifier><identifier>ISSN: 0929-5305</identifier><identifier>EISSN: 1573-742X</identifier><identifier>DOI: 10.1007/s11239-023-02802-0</identifier><identifier>PMID: 37017871</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Acute Disease ; Adult ; Aged ; Cardiology ; Clinical outcomes ; Clinical trials ; Embolism ; Feasibility Studies ; Female ; Fibrinolytic Agents ; Heart ; Hematology ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Pulmonary Embolism - surgery ; Pulmonary embolisms ; Reperfusion ; Suction - methods ; Suctioning ; Thrombectomy - methods ; Thrombolysis ; Thrombolytic Therapy - methods ; Thrombosis ; Treatment Outcome ; Venous Thromboembolism - etiology ; Ventricle</subject><ispartof>Journal of thrombosis and thrombolysis, 2023-05, Vol.55 (4), p.660-666</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-d77b28669fb869e41b3737f71af83896fd6d3054f1471af9db1ff503086ddab3</citedby><cites>FETCH-LOGICAL-c475t-d77b28669fb869e41b3737f71af83896fd6d3054f1471af9db1ff503086ddab3</cites><orcidid>0000-0002-6295-4905</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11239-023-02802-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11239-023-02802-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,315,787,791,892,1655,27985,27986,41485,42554,51702</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37017871$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kojodjojo, Pipin</creatorcontrib><creatorcontrib>Ong, Hean Ann</creatorcontrib><creatorcontrib>Loh, Poay Huan</creatorcontrib><creatorcontrib>Tay, Edgar</creatorcontrib><creatorcontrib>Chang, Peter</creatorcontrib><creatorcontrib>Kuntjoro, Ivandito</creatorcontrib><creatorcontrib>Low, Ting Ting</creatorcontrib><creatorcontrib>Lim, Yinghao</creatorcontrib><title>First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes</title><title>Journal of thrombosis and thrombolysis</title><addtitle>J Thromb Thrombolysis</addtitle><addtitle>J Thromb Thrombolysis</addtitle><description>Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE. Thus, a huge clinical need exists for an effective technique to restore pulmonary perfusion with minimal risk and avoidance of lytic therapy. In 2021, large bore suction thrombectomy (ST) was introduced in Asia for the first time and this study assessed the feasibility and short-term outcomes of Asian patients undergoing ST for acute PE. 40 consecutive patients (58% male, mean age of 58.3 ± 16.6 years) with intermediate (87.5%) or high-risk PE (12.5%) were enrolled in this prospective registry. 20% had prior VTE, 42.5% had contraindications to thrombolysis, and 10% failed to respond to thrombolysis. PE was idiopathic in 40%, associated with active cancer in 15% and post-operative status in 12.5%. Procedural time was 124 ± 30 min. Emboli were aspirated in all patients without the need for thrombolytics, resulting in a 21.4% reduction in mean pulmonary arterial pressures and 123% increase TASPE-PASP ratio, a prognostic measure of RV-arterial coupling. (both p < 0.001) Procedural complications were 5% and 87.5% patients survived to discharge without symptomatic VTE recurrence during 184 days of mean follow-up. ST affords an effective reperfusion option for PE without thrombolytics, normalises RV overload and provides excellent short-term clinical outcomes.
Key points
Large bore suction thrombectomy is an effective minimally invasive reperfusion therapy for patients with intermediate or high-risk pulmonary embolism (PE), without the use of thrombolytics.
Significant reductions in mean pulmonary arterial pressures and heart rates were achieved, resulting in normalisation of right ventricular (RV) strain, size and improvement in RV-pulmonary arterial coupling and stroke volumes.
95% of PE patients who did not require cardiopulmonary resuscitation, survived to discharge without VTE recurrence during 184 days of mean follow-up.
Ongoing multi-centre randomized controlled trials comparing suction thrombectomy to routine care will confirm the benefits of early catheter-based reperfusion therapy for PE.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Cardiology</subject><subject>Clinical outcomes</subject><subject>Clinical trials</subject><subject>Embolism</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Fibrinolytic Agents</subject><subject>Heart</subject><subject>Hematology</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Pulmonary Embolism - surgery</subject><subject>Pulmonary embolisms</subject><subject>Reperfusion</subject><subject>Suction - methods</subject><subject>Suctioning</subject><subject>Thrombectomy - methods</subject><subject>Thrombolysis</subject><subject>Thrombolytic Therapy - methods</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><subject>Venous Thromboembolism - etiology</subject><subject>Ventricle</subject><issn>1573-742X</issn><issn>0929-5305</issn><issn>1573-742X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kU1vVCEUhonR2Fr9Ay4MiRs3t_Jx58J1Y5rGWpMmuujCHQEuzNDwMfLRZH6Bf1umU2t14YJAOM95Dy8vAK8xOsUIsfcFY0LnARHaF0dkQE_AMV4xOrCRfH_66HwEXpRygxCaZ0SegyPKEGac4WPw88LlUmErBiYLvcxrM6iUDSxNV5cirJucgjK6prCDNmUodasGbpsPKcq8gyao5F0J0EV4VpwcvkntrNMfoDWyOOW8qzso4wLLJuU6VJMD1N5Fp6WHqVWdgikvwTMrfTGv7vcTcH3x6fr8crj6-vnL-dnVoEe2qsPCmCJ8mmar-DSbESvKKLMMS8spnye7TAtFq9HicX83Lwpbu0IU8WlZpKIn4ONBdttUMIs2sWbpxTa70L2IJJ34uxLdRqzTrdh_OGUcdYV39wo5_WimVBFc0cZ7GU1qRRA2T3jChJCOvv0HvUktx25P9LgYoRyPe0FyoHROpWRjH16D0d1YcchZ9JzFXc5i3_TmsY-Hlt_BdoAegNJLcW3yn9n_kf0Fa_e2dw</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Kojodjojo, Pipin</creator><creator>Ong, Hean Ann</creator><creator>Loh, Poay Huan</creator><creator>Tay, Edgar</creator><creator>Chang, Peter</creator><creator>Kuntjoro, Ivandito</creator><creator>Low, Ting Ting</creator><creator>Lim, Yinghao</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6295-4905</orcidid></search><sort><creationdate>20230501</creationdate><title>First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes</title><author>Kojodjojo, Pipin ; Ong, Hean Ann ; Loh, Poay Huan ; Tay, Edgar ; Chang, Peter ; Kuntjoro, Ivandito ; Low, Ting Ting ; Lim, Yinghao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-d77b28669fb869e41b3737f71af83896fd6d3054f1471af9db1ff503086ddab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Cardiology</topic><topic>Clinical outcomes</topic><topic>Clinical trials</topic><topic>Embolism</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Fibrinolytic Agents</topic><topic>Heart</topic><topic>Hematology</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Pulmonary Embolism - surgery</topic><topic>Pulmonary embolisms</topic><topic>Reperfusion</topic><topic>Suction - methods</topic><topic>Suctioning</topic><topic>Thrombectomy - methods</topic><topic>Thrombolysis</topic><topic>Thrombolytic Therapy - methods</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><topic>Venous Thromboembolism - etiology</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kojodjojo, Pipin</creatorcontrib><creatorcontrib>Ong, Hean Ann</creatorcontrib><creatorcontrib>Loh, Poay Huan</creatorcontrib><creatorcontrib>Tay, Edgar</creatorcontrib><creatorcontrib>Chang, Peter</creatorcontrib><creatorcontrib>Kuntjoro, Ivandito</creatorcontrib><creatorcontrib>Low, Ting Ting</creatorcontrib><creatorcontrib>Lim, Yinghao</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of thrombosis and thrombolysis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kojodjojo, Pipin</au><au>Ong, Hean Ann</au><au>Loh, Poay Huan</au><au>Tay, Edgar</au><au>Chang, Peter</au><au>Kuntjoro, Ivandito</au><au>Low, Ting Ting</au><au>Lim, Yinghao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes</atitle><jtitle>Journal of thrombosis and thrombolysis</jtitle><stitle>J Thromb Thrombolysis</stitle><addtitle>J Thromb Thrombolysis</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>55</volume><issue>4</issue><spage>660</spage><epage>666</epage><pages>660-666</pages><issn>1573-742X</issn><issn>0929-5305</issn><eissn>1573-742X</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><abstract>Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE. Thus, a huge clinical need exists for an effective technique to restore pulmonary perfusion with minimal risk and avoidance of lytic therapy. In 2021, large bore suction thrombectomy (ST) was introduced in Asia for the first time and this study assessed the feasibility and short-term outcomes of Asian patients undergoing ST for acute PE. 40 consecutive patients (58% male, mean age of 58.3 ± 16.6 years) with intermediate (87.5%) or high-risk PE (12.5%) were enrolled in this prospective registry. 20% had prior VTE, 42.5% had contraindications to thrombolysis, and 10% failed to respond to thrombolysis. PE was idiopathic in 40%, associated with active cancer in 15% and post-operative status in 12.5%. Procedural time was 124 ± 30 min. Emboli were aspirated in all patients without the need for thrombolytics, resulting in a 21.4% reduction in mean pulmonary arterial pressures and 123% increase TASPE-PASP ratio, a prognostic measure of RV-arterial coupling. (both p < 0.001) Procedural complications were 5% and 87.5% patients survived to discharge without symptomatic VTE recurrence during 184 days of mean follow-up. ST affords an effective reperfusion option for PE without thrombolytics, normalises RV overload and provides excellent short-term clinical outcomes.
Key points
Large bore suction thrombectomy is an effective minimally invasive reperfusion therapy for patients with intermediate or high-risk pulmonary embolism (PE), without the use of thrombolytics.
Significant reductions in mean pulmonary arterial pressures and heart rates were achieved, resulting in normalisation of right ventricular (RV) strain, size and improvement in RV-pulmonary arterial coupling and stroke volumes.
95% of PE patients who did not require cardiopulmonary resuscitation, survived to discharge without VTE recurrence during 184 days of mean follow-up.
Ongoing multi-centre randomized controlled trials comparing suction thrombectomy to routine care will confirm the benefits of early catheter-based reperfusion therapy for PE.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37017871</pmid><doi>10.1007/s11239-023-02802-0</doi><orcidid>https://orcid.org/0000-0002-6295-4905</orcidid><oa>free_for_read</oa></addata></record> |