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Pulmonary embolism reperfusion

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https://www.readbyqxmd.com/read/30025658/epidemiology-patterns-of-care-and-mortality-for-patients-with-hemodynamically-unstable-acute-symptomatic-pulmonary-embolism
#1
David Jiménez, Behnood Bikdeli, Deisy Barrios, Andrés Quezada, Jorge Del Toro, Gemma Vidal, Isabelle Mahé, Isabelle Quere, Mónica Loring, Roger D Yusen, Manuel Monreal
BACKGROUND: Limited information exists about the epidemiology, management and outcomes of hemodynamically unstable patients with acute pulmonary embolism (PE). We aimed to evaluate the prevalence and outcomes of unstable PE, and to assess the acute management in routine clinical practice. METHODS: This study included 34,380 patients from the RIETE registry with PE between 2001 and 2016. Primary outcomes included all-cause and PE-specific 30-day mortality. We used multivariable adjustments to calculate hazard ratios among unstable patients who did and did not receive reperfusion...
July 16, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29920349/bail-out-intracranial-stenting-with-solitaire-ab-device-after-unsuccessful-thrombectomy-in-acute-ischemic-stroke-of-anterior-circulation
#2
Sergio Nappini, Nicola Limbucci, Giuseppe Leone, Andrea Rosi, Leonardo Renieri, Arturo Consoli, Antonio Laiso, Iacopo Valente, Francesco Rosella, Riccardo Rosati, Salvatore Mangiafico
BACKGROUND: Recent trials established the efficacy of mechanical stent-retriever thrombectomy for treatment of stroke patients with large vessel occlusion (LVO) in the anterior circulation. However, stent-retriever thrombectomy may not accomplish successful recanalization in all patients. The aim of this study is to report the role of bail-out permanent stenting after failure of mechanical thrombectomy. METHODS: Among 430 patients included in a prospectively maintained database, we analysed 325 cases of anterior circulation LVO...
June 18, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
https://www.readbyqxmd.com/read/29898910/fulminant-pulmonary-embolism-with-fatal-outcome-in-a-patient-with-low-clinical-prediction-scores
#3
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
https://www.readbyqxmd.com/read/29848934/extracorporeal-membrane-oxygenation-improved-survival-in-patients-with-massive-pulmonary-embolism
#4
Donggyu Moon, Su Nam Lee, Ki-Dong Yoo, Min Seop Jo
BACKGROUND: Current guidelines for massive pulmonary embolism (PE) treatment recommend primary reperfusion therapy and the option of extracorporeal membrane oxygenation (ECMO). However, these recommendations might not be optimal for patients with poor prognoses who are in cardiogenic shock (CS) or require cardiopulmonary resuscitation (CPR). OBJECTIVE: Evaluate the impact of ECMO support on the clinical outcome of patients with massive PE complicated by CPR or CS...
May 2018: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/29843174/reperfusion-treatment-for-acute-pulmonary-embolism
#5
Rolf P Engelberger, Nils Kucher
Due to the manifold treatment options for the management of acute pulmonary embolism, state-of-the-art management requires risk stratification for choosing the adapted treatment for each patient. Reperfusion therapy is an integral part of therapy for patients with pulmonary embolism at high risk for mortality, but its role in patients with intermediate risk pulmonary embolism is more debated. The largest amount of evidence exists for systemic thrombolysis, which is an efficient therapy, but at the prize of an increased bleeding risk...
May 2018: Hämostaseologie
https://www.readbyqxmd.com/read/29375141/reperfusion-after-pulmonary-embolism-long-term-follow-up-risk-factors-clinical-impact
#6
Jan Mrozek, Jana Petrova, Jana Vaclavkova, Vladimir Janovsky, Lubos Kraus, Pavel Jansa
BACKGROUND AND AIM: Thromboembolic disease is the third most common cardiovascular disorder and deep vein thrombosis carries the risk of pulmonary embolism (PE). Questions related to reperfusion after PE remain, especially risk factors. Incomplete reperfusion after PE is closely related to the development of chronic thromboembolic pulmonary hypertension. The aim of this study was to determine the relation between reperfusion after PE in the long term over a period of 24 months, laboratory results and clinical risk factors found during the initial PE event...
June 2018: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
https://www.readbyqxmd.com/read/29302122/rvad-support-in-the-setting-of-submassive-pulmonary-embolism
#7
Antonio Salsano, Elena Sportelli, Guido Maria Olivieri, Nicola Di Lorenzo, Silvia Borile, Francesco Santini
Patients with submassive pulmonary embolism (PE), although normotensive, are characterized by right ventricular (RV) dysfunction and elevated levels of biomarkers of cardiac damage. The best treatment option in these cases is still a subject of debate and the use of thrombolysis in submassive PE remains controversial. A 57-year-old Caucasian male with unprovoked PE, normal blood pressure, and elevated troponin I values was referred to the cardiovascular department. In view of the presence of a right atrium thrombus, the patient underwent surgical embolectomy under extracorporeal circulation, with the extraction of a huge thrombus together with fragmented thrombi from both pulmonary arteries...
December 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/29143501/-the-place-of-balloon-pulmonary-angioplasty-in-the-management-of-chronic-thromboembolic-pulmonary-hypertension
#8
Aileen Kharat, Béatrice Duxbury, Anne-Lise Hachull, Stéphane Noble, Hélène Bouvaist, Paola M Soccal, Frédéric Lador
Chronic thromboembolic pulmonary hypertension (CTEPH) is uncommon. Its diagnosis should not be delayed as its prognosis is poor if not treated. In most cases, an acute pulmonary embolism is found in the medical history of the patient. Once suspected, a specific work-up should be performed in a pulmonary hypertension (PH) center. The ventilation/perfusion scan has a central role in this workup but the emergence of non invasive imaging technologies provides morphological and functional information which take part in the therapeutic decision making, such as operability...
November 15, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29117205/hypoxia-preconditioned-mesenchymal-stem-cells-ameliorate-ischemia-reperfusion-induced-lung-injury
#9
Yung-Yang Liu, Chi-Huei Chiang, Shih-Chieh Hung, Chih-Feng Chian, Chen-Liang Tsai, Wei-Chih Chen, Haibo Zhang
BACKGROUND: Hypoxia preconditioning has been proven to be an effective method to enhance the therapeutic action of mesenchymal stem cells (MSCs). However, the beneficial effects of hypoxic MSCs in ischemia/reperfusion (I/R) lung injury have yet to be investigated. In this study, we hypothesized that the administration of hypoxic MSCs would have a positive therapeutic impact on I/R lung injury at molecular, cellular, and functional levels. METHODS: I/R lung injury was induced in isolated and perfused rat lungs...
2017: PloS One
https://www.readbyqxmd.com/read/28942971/survival-and-recurrence-after-acute-pulmonary-embolism-treated-with-pulmonary-embolectomy-or-thrombolysis-in-new-york-state-1999-to-2013
#10
Timothy Lee, Shinobu Itagaki, Yuting P Chiang, Natalia N Egorova, David H Adams, Joanna Chikwe
BACKGROUND: Pulmonary embolism (PE) results in more than 250,000 hospitalizations annually in the United States, with high mortality. Outcome data are limited, and reperfusion strategies remain controversial. Here we evaluated the outcomes of thrombolysis and surgical embolectomy in patients with acute PE using a statewide database. METHODS: Among 174,322 patients hospitalized with PE in New York State between 1999 and 2013, we performed a retrospective comparison of 2111 adults with acute PE who underwent either thrombolysis (n = 1854; 88%) or surgical embolectomy (n = 257; 12%) as first-line therapy...
March 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28831930/-pulmonary-embolism-response-teams-what-is-the-added-value-for-patients-with-acute-pulmonary-embolism
#11
M V Huisman, J M Montero Cabezas, F A Klok
Adequate triaging of patients presenting with acute pulmonary embolism (PE) is essential for appropriate treatment, especially for patients with severe PE. Optimal treatment for this latter group of patients includes pharmaco-mechanical reperfusion treatment for the minority of patients who present with haemodynamic instability, and standard anticoagulation and close monitoring on the ward for the intermediate-high risk patient. In the USA, pulmonary embolism response teams (PERT) have been introduced to coordinate triaging of these patients...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28663958/thrombus-removal-by-acute-phase-endovascular-reperfusion-therapy-to-treat-cerebral-embolism-caused-by-thrombus-in-the-pulmonary-vein-stump-after-left-upper-pulmonary-lobectomy-case-report
#12
Hiroyuki Ikeda, Norikazu Yamana, Yoshitake Murata, Masaaki Saiki
Thrombus formation in a pulmonary vein stump after pulmonary lobectomy is extremely rare, but can trigger cerebral embolism of unknown cause. We encountered a case of cerebral embolism in a 58-year-old man 2 days after left upper lobectomy. Since intravenous administration of recombinant tissue plasminogen activator was contraindicated, thrombus removal by endovascular reperfusion therapy was performed. Cerebral angiography showed left internal carotid artery occlusion. Thrombus removal using a retrieval device was performed and complete recanalization of the left internal carotid artery was obtained...
January 2015: NMC Case Report Journal
https://www.readbyqxmd.com/read/28595772/prevention-of-early-complications-and-late-consequences-after-acute-pulmonary-embolism-focus-on-reperfusion-techniques
#13
Stavros V Konstantinides, Stefano Barco
Pulmonary embolism (PE) is a major cause of acute cardiovascular mortality and long-term morbidity. Right ventricular (RV) dysfunction is the key determinant of prognosis in the acute phase of PE, and residual RV dysfunction is associated with the development of post-PE functional impairment, chronic thromboembolic disease, and higher costs of treatment over the long term. Patients with clinically overt RV failure, i.e. hemodynamic collapse at presentation (high-risk PE), necessitate immediate thrombolytic treatment to relieve the obstruction in the pulmonary circulation; surgical or catheter-directed removal of the thrombus can be an alternative option...
April 2018: Thrombosis Research
https://www.readbyqxmd.com/read/28553870/changing-the-strategy-of-balloon-pulmonary-angioplasty-resulted-in-a-reduced-complication-rate-in-patients-with-chronic-thromboembolic-pulmonary-hypertension-a-single-centre-european-experience
#14
Marcin Kurzyna, Szymon Darocha, Radosław Pietura, Arkadiusz Pietrasik, Justyna Norwa, Rafał Mańczak, Maria Wieteska, Andrzej Biederman, Hiromi Matsubara, Adam Torbicki
BACKGROUND AND AIM: To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28347320/life-threatening-massive-pulmonary-embolism-rescued-by-venoarterial-extracorporeal-membrane-oxygenation
#15
Fillipo Corsi, Guillaume Lebreton, Nicolas Bréchot, Guillaume Hekimian, Ania Nieszkowska, Jean-Louis Trouillet, Charles-Edouard Luyt, Pascal Leprince, Jean Chastre, Alain Combes, Matthieu Schmidt
BACKGROUND: Despite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation. METHODS: ECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006-2015)...
March 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28262244/risk-adapted-management-of-pulmonary-embolism
#16
REVIEW
Stefano Barco, Stavros V Konstantinides
The presence and severity of right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of pulmonary embolism (PE). Risk-adapted treatment strategies continue to evolve, tailoring initial management to the clinical presentation and the functional status of the RV. Beyond pharmacological and, if necessary, mechanical circulatory support, systemic thrombolysis remains the mainstay of treatment for hemodynamically unstable patients; in contrast, it is not routinely recommended for intermediate-risk PE...
March 2017: Thrombosis Research
https://www.readbyqxmd.com/read/28256427/midterm-effect-of-balloon-pulmonary-angioplasty-on-hemodynamics-and-subclinical-myocardial-damage-in-chronic-thromboembolic-pulmonary-hypertension
#17
Mai Kimura, Takashi Kohno, Takashi Kawakami, Masaharu Kataoka, Toshimitsu Tsugu, Keitaro Akita, Sarasa Isobe, Yuji Itabashi, Yuichiro Maekawa, Mitsushige Murata, Keiichi Fukuda
BACKGROUND: The acute favourable effect of balloon pulmonary angioplasty (BPA) has been proven in patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, data on its effect 6 months after therapy (from now on referred to as mid-term) and influence on the right ventricle and myocardial damage are sparse. To evaluate factors that influence improvement in cardiac output (CO) and subclinical myocardial damage, we examined hemodynamics and serum high-sensitivity troponin T (hs-TnT) levels before, 1 week after, and 6 months after BPA...
April 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28208199/systemic-thrombolytic-therapy-for-acute-pulmonary-embolism-who-is-a-candidate
#18
REVIEW
Stavros V Konstantinides, Stefano Barco
Pulmonary embolism (PE) is a major cause of both acute and long-term morbidity for a large number of patients worldwide, and massive PE is frequently fatal. Right ventricular (RV) dysfunction is a key determinant of prognosis in the acute phase of PE. Patients with clinically overt RV failure, that is, with cardiogenic shock or persistent hypotension at presentation (acute high-risk PE), are clearly in need of immediate reperfusion treatment with systemic thrombolysis or, alternatively, surgical or catheter-directed techniques...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28168659/btp2-a-store-operated-calcium-channel-inhibitor-attenuates-lung-ischemia-reperfusion-injury-in-rats
#19
Wei Zhang, Zeyou Qi, Yaping Wang
Lung ischemia-reperfusion (I/R) injury is a critical complication following a lung transplant, cardiopulmonary bypass, pulmonary embolism, and trauma. Immune cells and their effector functions are involved in the lung I/R injury. Store-operated calcium channels (SOCC) are highly Ca2+ -selective cation channels and have crucial effects on the immune system. It has been indicated that BTP2, a potent SOCC blocker, could inhibit pro-inflammatory cytokine production from immune cells both in vitro and in vivo. Therefore, this study was conducted to investigate the beneficial effects of BTP2 on lung I/R injury in Sprague-Dawley (SD) rats...
June 2017: Inflammation
https://www.readbyqxmd.com/read/28145907/evaluation-of-reperfusion-pulmonary-edema-by-extravascular-lung-water-measurements-after-pulmonary-endarterectomy
#20
François Stéphan, Aurélien Mazeraud, Florent Laverdure, Julien Camous, Elie Fadel
OBJECTIVES: Reperfusion pulmonary edema is a specific complication of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. Extravascular lung water measurement may be valuable for diagnosing reperfusion pulmonary edema. The primary objective of this study was to describe and assess the clinical significance of extravascular lung water variations after pulmonary endarterectomy. DESIGN: Prospective observational study. SETTING: Nineteen-bed cardiothoracic ICU...
April 2017: Critical Care Medicine
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