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Barbara L LeVarge, Cameron D Wright, Josanna M Rodriguez-Lopez
Surgical pulmonary embolectomy and pulmonary thromboendarterectomy are well-established treatment strategies for patients with acute and chronic pulmonary embolism, respectively. For both procedures, techniques and outcomes have evolved considerably over the past decades. Patients with massive and submassive acute pulmonary embolism are at risk for rapid decline owing to right ventricular failure and shock. When thrombus is proximal, embolectomy can rapidly restore cardiac function. Chronic thromboembolic pulmonary hypertension is a more complex disease that requires skilled, careful dissection of the arterial wall, including vascular intima...
September 2018: Clinics in Chest Medicine
Jeffrey S Pollak
More aggressive therapy for acute pulmonary embolism beyond anticoagulation is indicated in patients at higher risk for mortality and morbidity, namely those suffering from massive and possibly submassive disease. Catheter-based thrombolysis, catheter-based mechanical thrombus debulking, or combinations of these offer opportunities for rapid clot reduction and clinical improvement with a lower bleeding risk than systemic thrombolysis and perhaps greater efficacy. Optimal low-dose regimens for direct thrombolysis have not been defined just as optimal techniques and devices for mechanical therapy have not been developed, underscoring the need for further work...
September 2018: Clinics in Chest Medicine
Eric Secemsky, Yuchiao Chang, C Charles Jain, Joshua A Beckman, Jay Giri, Michael R Jaff, Kenneth Rosenfield, Rachel Rosovsky, Christopher Kabrhel, Ido Weinberg
BACKGROUND: Few contemporary studies have assessed the management and outcomes of patients with massive and submassive pulmonary embolism. Given advances in therapy, we report contemporary practice patterns and event rates among these patients. METHODS: We analyzed a prospective database of patients with massive and submassive pulmonary embolism. We report clinical characteristics, therapies and outcomes stratified by pulmonary embolism type. Treatment escalation beyond systemic anticoagulation was defined as advanced therapy...
August 10, 2018: American Journal of Medicine
Ewa Konik, Nandan S Anavekar, Waldemar Wysokinski, Krishnaswamy Chandrasekaran
No abstract text is available yet for this article.
April 2018: CASE: Cardiovascular Imaging Case Reports
Kelly Galanos, Cassie Jaeger, Kevin Coakley, Peter White, David Griffen
Treatment recommendations for submassive pulmonary embolus (SMPE), defined as pulmonary embolus (PE) resulting in right ventricular dysfunction and/or myocardial necrosis, vary. The objective of this study was to develop an investigative protocol at our tertiary care hospital to standardise the approach to patients with SMPE and to evaluate the effect of the protocol on process measures including consultation with cardiology and critical care physicians and time to echocardiogram and treatment. Triggered by right ventricle/left ventricle ratios >0...
2018: BMJ open quality
Akhilesh K Sista
No abstract text is available yet for this article.
July 23, 2018: JACC. Cardiovascular Interventions
Victor F Tapson, Keith Sterling, Noah Jones, Mahir Elder, Uttam Tripathy, Jayson Brower, Robert L Maholic, Charles B Ross, Kannan Natarajan, Pete Fong, Lee Greenspon, Houman Tamaddon, Amir R Piracha, Tod Engelhardt, John Katopodis, Vasco Marques, Andrew S P Sharp, Gregory Piazza, Samuel Z Goldhaber
OBJECTIVES: The aim of this study was to determine the lowest optimal tissue plasminogen activator (tPA) dose and delivery duration using ultrasound-facilitated catheter-directed thrombolysis (USCDT) for the treatment of acute intermediate-risk (submassive) pulmonary embolism. BACKGROUND: Previous trials of USCDT used tPA over 12 to 24 h at doses of 20 to 24 mg for acute pulmonary embolism. METHODS: Hemodynamically stable adults with acute intermediate-risk pulmonary embolism documented by computed tomographic angiography were randomized into this prospective multicenter, parallel-group trial...
July 23, 2018: JACC. Cardiovascular Interventions
Nematullah Sharaf, Victoria B Sharaf, Sharon E Mace, Amy S Nowacki, James K Stoller, John C Carl
BACKGROUND: D-dimer is used to aid in diagnosing adult pulmonary embolism (PE). D-dimer has not been validated in adolescents. Clinicians must balance the risk of overtesting with that of a missed PE. D-dimer may be useful in this context. This study evaluates D-dimer in PE-positive and PE-negative adolescents. METHODS: PE-positive patients < 22 years were diagnosed with PE by computed tomography (CT) or high-probability ventilation/perfusion, seen at emergency departments (EDs)/hospitals within a 16-hospital system across two states, January 1998 through December 2016...
July 16, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Murat Gök, Alparslan Kurtul, Murat Harman, Meryem Kara, Muhammed Süleymanoglu, Ender Ornek
In this study, the association between the right ventricular dysfunction (RVD) and CHA2DS2-VASc (C: congestive heart failure or left ventricular systolic dysfunction, H: hypertension, A: age of ≥ 75 years, D: diabetes mellitus, S: previous stroke, V: vascular disease, A: age between 65 and 74 years, Sc: female gender) scores was investigated in patients with acute pulmonary thromboembolism (PTE). The patients have been assigned to 3 subgroups as massive, submassive, and nonmassive PTE. The CHA2DS2-VASc scores were calculated for all of the patients, and the scores have been classified into 3 groups as the scores between 0 and 1, the scores of 2, and the scores of 3 and over...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Massimo Pieraccini, Susanna Guerrini, Edoardo Laiolo, Alessio Puliti, Giandomenico Roviello, Leonardo Misuraca, Genni Spargi, Ugo Limbruno, Mauro Breggia, Morando Grechi
PURPOSE: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. MATERIALS AND METHODS: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4)...
July 6, 2018: Cardiovascular and Interventional Radiology
Eulo Lupi-Herrera, María Elena Soto-López, Antonio de Jesús Lugo-Dimas, Marcela Elizabeth Núñez-Martínez, Ricardo Gamboa, Claudia Huesca-Gómez, Lilia Mercedes Sierra-Galán, Verónica Guarner-Lans
The activity of the enzyme methylenetetrahydrofolate reductase (MTHFR) determines homocysteine (Hcy) levels, and polymorphisms in its gene affect the activity of the enzyme. Changes in the enzyme's activity may lead to a higher susceptibility to develop arterial and venous thromboembolic disease. The aim was to analyze the relationship between the C677T and A1298C polymorphisms of MTHFR, Hcy levels, and prothrombotic biomarkers in pulmonary embolism (PE) and acute myocardial ischemia (AMI). Clinical files of patients with thromboembolic diseases having complete data and whose doctor had requested an assay to determine the polymorphisms of the MTHFR gene, Hcy levels, and prothrombotic biomarkers were studied to search for the correlation between mutations of the MTHFR gene and Hcy levels in the different diseases...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Christian Degen, Severin Poechtrager, Gregor Leibundgut
We present a case of a 72-year-old man with submassive acute pulmonary thromboembolism. Pulmonary embolism severity index Score and common clinical risk stratification recommended systemic anticoagulation and a clinical course without complications was expected. A primary reperfusion strategy was not indicated by the current guidelines. Under established anticoagulation, the patient was found in cardiac arrest immediately after mobilisation from the bed the next morning. Right heart catheterisation under ongoing resuscitation revealed a complete obstruction of the right pulmonary artery by a big thrombus...
June 13, 2018: BMJ Case Reports
Zlatko Devcic, William T Kuo
Catheter-directed therapy (CDT) is now acknowledged as a treatment option for select patients with acute massive or submassive pulmonary embolism (PE), and more patients are being considered for CDT if there is available expertise. Therefore, interventionalists should be aware of the variety of catheter-based treatment options, specific pitfalls to avoid during therapy, and the appropriate treatment endpoints. This article reviews currently available techniques and protocols for treating acute massive and submassive PE, with tips to safely and successfully perform percutaneous PE interventions...
June 2018: Seminars in Interventional Radiology
Matthew A Chiarello, Akhilesh K Sista
Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality in the United States. PE associated with right ventricular strain, termed submassive or intermediate-risk PE, is associated with an increased rate of clinical deterioration and short-term mortality. Trials have demonstrated systemic thrombolytics may improve patient outcomes, but they carry a risk of major hemorrhage. Catheter-directed thrombolysis (CDT) may offer similar efficacy to and a lower risk of catastrophic hemorrhage than systemic thrombolysis...
June 2018: Seminars in Interventional Radiology
Tamir Friedman, Ronald S Winokur, Keith B Quencer, David C Madoff
Pulmonary embolism (PE) is currently the third leading cause of death and moreover is likely underdiagnosed. PE remains the most common preventable cause of hospital deaths in the United States, which may be attributable to its diagnostic challenges. Although difficult to diagnose, patient mortality rates are time-dependent, and thus, the suspicion and diagnosis of PE in a timely manner is imperative. Diagnosis based on several criteria which may dictate imaging workup as well as laboratory tests and clinical parameters are discussed...
June 2018: Seminars in Interventional Radiology
Samantha J Myers, Thomas E Kelly, Jeffrey R Stowell
Pulmonary embolism is associated with significant mortality and impaired long-term functional outcomes. Timely identification and treatment is crucial for successful management. Unfortunately, prompt diagnosis can be challenging in patients without overt signs of cardiovascular compromise. Point-of-care cardiac ultrasound (POCCUS) can be used to identify signs of acute pulmonary embolism, risk stratify patients for adverse outcomes and assess response to therapy. This report describes a patient with submassive pulmonary embolism and evidence of acute right ventricular strain on POCCUS successfully treated with thrombolytic therapy...
November 2017: Clinical practice and cases in emergency medicine
Jessica Andrusaitis, Mohammad Helmy, Christopher E McCoy, Wirachin Hoonpongsimanont, Bharath Chakravarthy, Shahram Lotfipour
Massive and submassive pulmonary emboli (PE) are rare but potentially life-threatening medical conditions that necessitate immediate recognition and appropriate treatment. We report a 52-year-old man who was found to have a submassive central saddle and extensive bilateral PEs after experiencing a syncopal event and who had evidence of right heart strain and pulmonary hypertension. He was subsequently treated with catheter-assisted thrombectomy and pulmonary artery tissue plasminogen activator administration...
February 2018: Clinical practice and cases in emergency medicine
Xi Xue, Akhilesh K Sista
Acute pulmonary embolism (PE) is a major public health problem. It is the third most common cause of death in hospitalized patients. In the United States, there are up to 600,000 cases diagnosed per year with 100,000-180,000 acute PE-related deaths. Common risk factors include underlying genetic conditions, acquired conditions, and acquired hypercoagulable states. Acute PE increases the pulmonary vascular resistance and the load on the right ventricle (RV). Increased RV loading causes compensatory RV dilation, impaired contractility, tachycardia, and sympathetic activation...
June 2018: Techniques in Vascular and Interventional Radiology
Annie Amin, Jason Scott Lane
PURPOSE OF REVIEW: To review novel procedures in interventional radiology and describe anesthetic implications. RECENT FINDINGS: Noninvasive treatment options for patients who are nonsurgical candidates are on the rise. The complication rate for patients receiving anesthesia in the interventional radiology suite is higher than other nonoperating room anesthetizing locations. The investigative use of catheter-directed thrombolysis for acute submassive pulmonary embolism will likely lead to an increased demand for anesthesia assistance...
August 2018: Current Opinion in Anaesthesiology
Taishi Hirai, Steven Tate, Kathryn Dryer, Deshon Jones, Jonathan Rosenberg, Sandeep Nathan, Atman P Shah, Kyle Carey, Matthew Churpek, Dana Edelson, Janet Friant, Jonathan Paul, John E A Blair
OBJECTIVE: To determine if the cardiac arrest triage (CART) Score would better predict poor outcomes after pharmacomechanical therapy (PMT) for massive and submassive pulmonary embolism (PE) than traditional risk scores BACKGROUND: PMT for massive and submassive PE allows for clot lysis with minimal doses of fibrinolytics. Although PMT results in improved right ventricular function, and reduced pulmonary pressures and thrombus burden, predictors of poor outcome are not well-studied. METHODS: We conducted a retrospective analysis of all patients who underwent PMT for massive or submassive PE at a single institution from 2010 to 2016...
May 10, 2018: Catheterization and Cardiovascular Interventions
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