Bengü SAYLAN, Tayfun ÇALIŞKAN, Kadir CANOĞLU, Ali Ertan ULUCAN, Ahmet Turan YILMAZ

EkoSonicTM endovasküler sistem ile tedavi edilen pulmoner embolili hastaların analizi

Amaç: Bu çalışmada, orta-yüksek riskli pulmoner emboli tanısıyla hastaneye yatırılan hastalardaki EkoSonic™ endovasküler sistem uygulamalarının etkinliği ve güvenliliği değerlendirildi. Çalışma planı: Ocak 2018 - Mart 2019 tarihleri arasında, pulmoner emboli nedeniyle EkoSonic™ endovasküler sistemi kullanılarak ultrasonografi ile hızlandırılmış tromboliz yapılan toplam 15 hasta (7 erkek, 8 kadın; ort. yaş 64.7±17.8 yıl; dağılım, 35-90 yıl) retrospektif olarak incelendi. Pulmoner emboli tanısı, pulmoner bilgisayarlı tomografi anjiyografi ile konuldu. Hastaların tümü sağ ventrikül disfonksiyonu açısından ekokardiyografi ile değerlendirildi ve serum troponin I ve beyin natriüretik peptid düzeyleri kaydedildi. Bulgular: Hastaların işlem öncesinde ve sonrasında ortalama arteriyel kan gazı oksijen satürasyon değerleri sırasıyla %86.3±3.5 ve %94.2±2.5 olup, istatistiksel olarak anlamlı fark saptandı (p=0.001). İşlem öncesinde ve sonrasında ortalama parsiyel oksijen basıncı değerleri 73.3±7.7 mmHg ve 90.7±5.0 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p=0.001). İşlem öncesinde ve sonrasında ortalama sağ ventrikül çapı açısından da istatistiksel olarak anlamlı bir fark vardı (p=0.001). İşlem öncesinde ve sonrasında ortalama pulmoner arter basıncı sırasıyla 44±7.1 mmHg ve 36.3±4.5 mmHg olup, istatistiksel olarak anlamlı fark saptandı (p=0.001). Hastaların %93.7’sinde işlem sonrasında komplikasyon gözlenmedi. Sonuç: EkoSonic™ endovasküler system orta-yüksek riskli pulmoner emboli hastalarında kanama riskinde bir artışa neden olmaksızın sağ ventrikül disfonksiyonunu iyileştirdi; pulmoner arter basıncını azalttı ve oksijenasyonu düzeltti.

Analysis of pulmonary embolism patients treated with EkoSonic™ endovascular system

Background: The aim of this study was to evaluate theefficacy and the safety of the EkoSonic™ endovascular systemapplications in patients hospitalized with the diagnosis ofintermediate-high-risk pulmonary embolism.Methods: Between January 2018 and March 2019, a total of15 patients (7 males, 8 females; mean age 64.7±17.8 years,range, 35 to 90 years) who underwent ultrasound-acceleratedthrombolysis using the EkoSonic™ endovascular system forpulmonary embolism were retrospectively analyzed. Thediagnosis of pulmonary embolism was made based on pulmonarycomputed tomography angiography. All patients were evaluatedby echocardiography for right ventricular dysfunction and serumlevels of troponin I and brain natriuretic peptide were recorded.Results: The mean arterial blood gas oxygen saturation valuesof the patients before and after the procedure were 86.3±3.5%and 94.2±2.5%, respectively, indicating a statistically significantdifference (p=0.001). The mean partial oxygen pressurevalues before and after the procedure were 73.3±7.7 mmHgand 90.7±5.0 mmHg, respectively, indicating a statisticallysignificant difference (p=0.001). There was also a statisticallysignificant difference in the mean right ventricular diameterbefore and after the procedure (p=0.001). The mean pre- andpost-procedural pulmonary arterial pressure was 44±7.1 mmHgand 36.3±4.5 mmHg, respectively, indicating a statisticallysignificant difference (p=0.001). Of the patients, 93.7% were freefrom post-procedural complications.Conclusion: The EkoSonic™ endovascular system improved rightventricular dysfunction, decreased pulmonary arterial pressure,and improved oxygenation in patients with intermediate-high-riskpulmonary embolism without increasing the risk for bleeding

PDF

___

1. Schulman S, Ageno W, Konstantinides SV. Venous thromboembolism: Past, present and future. Thromb Haemost 2017;117:1219-29.
2. Wendelboe AM, Raskob GE. Global Burden of Thrombosis: Epidemiologic Aspects. Circ Res 2016;118:1340-7.
3. Centers for Disease Control and Prevention (CDC). Venous thromboembolism in adult hospitalizations - United States, 2007-2009. MMWR Morb Mortal Wkly Rep 2012;61:401-4.
4. Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41:543-603.
5. Konstantinides S. Pulmonary embolism: impact of right ventricular dysfunction. Curr Opin Cardiol 2005;20:496-501.
6. Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA 2014;311:2414-21.
7. Konstantinides SV, Vicaut E, Danays T, Becattini C, Bertoletti L, Beyer-Westendorf J, et al. Impact of Thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. J Am Coll Cardiol 2017;69:1536-44.
8. Kline JA, Steuerwald MT, Marchick MR, Hernandez-Nino J, Rose GA. Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure. Chest 2009;136:1202-10.
9. Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M; “MOPETT” Investigators. Moderate pulmonary embolism treated with thrombolysis (from the "MOPETT" Trial). Am J Cardiol 2013;111:273-7.
10. Eberle H, Lyn R, Knight T, Hodge E, Daley M. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol 2013;111:273-7.
11. Reis SP, Zhao K, Ahmad N, Widemon RS, Root CW, Toomay SM, et al. Acute pulmonary embolism: endovascular therapy. Cardiovasc Diagn Ther 2018;8:244-52.
12. Engelberger RP, Kucher N. Reperfusion Treatment for Acute Pulmonary Embolism. Hamostaseologie 2018;38:98-105.
13. Kucher N, Boekstegers P, Müller OJ, Kupatt C, BeyerWestendorf J, Heitzer T, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 2014;129:479-86.
14. Tapson VF, Sterling K, Jones N, Elder M, Tripathy U, Brower J, et al. A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Risk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018;11:1401-10.
15. Piazza G, Hohlfelder B, Jaff MR, Ouriel K, Engelhardt TC, Sterling KM, et al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv 2015;8:1382-92.
16. Carroll BJ, Goldhaber SZ, Liu PY, Piazza G. Ultrasoundfacilitated, catheter-directed, low-dose fibrinolysis in elderly patients with pulmonary embolism: A SEATTLE II subanalysis. Vasc Med 2017;22:324-30.
17. McCabe JM, Huang PH, Riedl L, Eisenhauer AC, Sobieszczyk P. Usefulness and safety of ultrasound-assisted catheterdirected thrombolysis for submassive pulmonary emboli. Am J Cardiol 2015;115:821-4.
18. Bagla S, Smirniotopoulos JB, van Breda A, Sheridan MJ, Sterling KM. Ultrasound-accelerated catheter-directed thrombolysis for acute submassive pulmonary embolism. J Vasc Interv Radiol 2015;26:1001-6.
19. Engelberger RP, Spirk D, Willenberg T, Alatri A, Do DD, Baumgartner I, et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis. Circ Cardiovasc Interv 2015;8. pii: e002027.
20. Rothschild DP, Goldstein JA, Ciacci J, Bowers TR. Ultrasound-accelerated thrombolysis (USAT) versus standard catheter-directed thrombolysis (CDT) for treatment of pulmonary embolism: A retrospective analysis. Vasc Med 2019;24:234-40.
21. Kuo WT, Banerjee A, Kim PS, DeMarco FJ Jr, Levy JR, Facchini FR, et al. Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): Initial Results From a Prospective Multicenter Registry. Chest 2015;148:667-73.
22. Liang NL, Avgerinos ED, Marone LK, Singh MJ, Makaroun MS, Chaer RA. Comparative Outcomes of UltrasoundAssisted Thrombolysis and Standard Catheter-Directed Thrombolysis in the Treatment of Acute Pulmonary Embolism. Vasc Endovascular Surg 2016;50:405-10.
23. ULTRAsound-assisted Catheter vs. STAndaRd Catheter Thrombolysis for Submassive Pulmonary Embolism (UltraStar sPE). ClinicalTrials.gov Identifier: NCT03086317 Available at: https://clinicaltrials.gov/ct2/show/ NCT03389971.
24. Standard vs. Ultrasound-assisted Catheter Thrombolysis for Submassive Pulmonary Embolism (SUNSET sPE). ClinicalTrials.gov Identifier: NCT02758574 Available at: https://clinicaltrials.gov/ct2/show/NCT02758574.
25. Sharifi M, Awdisho A, Schroeder B, Jiménez J, Iyer P, Bay C. Retrospective comparison of ultrasound facilitated catheterdirected thrombolysis and systemically administered halfdose thrombolysis in treatment of pulmonary embolism. Vasc Med 2019;24:103-9.
26. Kaymaz C, Öztürk S, Akbal Ö, Tanboğa IH, Yılmaz F, Poçi N, et al. Ultrasound-assisted catheter-directed thrombolysis in high-risk and intermediate-high-risk pulmonary embolism: results from a single-center cohort. Angiology 2017;68:433-40.
27. Kolkailah AA, Hirji S, Piazza G, Ejiofor JI, Ramirez Del Val F, Lee J, et al. Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism. J Card Surg 2018;33:252-9.
28. Keeling WB, Sundt T, Leacche M, Okita Y, Binongo J, Lasajanak Y, et al. Outcomes After Surgical Pulmonary Embolectomy for Acute Pulmonary Embolus: A MultiInstitutional Study. Ann Thorac Surg 2016;102:1498-502.