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https://www.readbyqxmd.com/read/29327535/catheter-assisted-management-of-massive-pulmonary-embolism
#1
Amey Beedkar, Rohan Parikh, Bhavesh Patel, Mahendra Mhaske, Sunil Washimkar, Pradeep Deshmukh, Mukund Deshpande
Pulmonary thromboembolism is common and missed by clinicians. We report a case of massive pulmonary embolism which was life threatening treated by the catheter assisted technique. Anticoagulation is the mainstay of therapy for most patients, with thrombolytic therapy reserved for some patients.1 Recent studies have suggested a role for systemic or catheter-directed thrombolytic therapy in selected patients.2 We present a case of a patient who presented with an PE, was successfully treated with catheter-directed thrombolysis...
December 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/29326820/a-case-of-intra-arterial-thrombolysis-with-alteplase-in-a-patient-with-hypothenar-hammer-syndrome-but-without-underlying-aneurysm
#2
Harshal Shukla, Vicken Yaghdjian, Issam Koleilat
Hypothenar hammer syndrome is a cause of symptomatic ischemia of the hand secondary to the formation of aneurysm or thrombosis of the ulnar artery in the setting of a complete or incomplete palmar arch. Acute occlusive thrombus or embolus of the hand represents a complex problem that often may require immediate surgical intervention. We report a case of acute unilateral arterial hand ischemia requiring catheter-directed thrombolysis with Alteplase therapy in a patient with acute occlusive arterial thrombosis of the left ulnar artery...
2018: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29249865/heparin-induced-thrombocytopenia-and-thrombosis-preventing-your-thrombolysis-practice-from-taking-a-hitt
#3
REVIEW
Eric Wannamaker, Kimi Kondo, D Thor Johnson
Heparin-induced thrombocytopenia and thrombosis (HITT) is an under-recognized cause of deep venous thrombosis treatment failure and of complications during catheter-directed thrombolysis. After a review of HITT pathophysiology, diagnosis, and management, three different cases are presented in this article. Each case highlights subtleties and challenges of HITT diagnosis and management. An example of a practical approach to the diagnosis of HITT is presented.
December 2017: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/29248101/design-and-rationale-of-a-randomized-trial-comparing-standard-versus-ultrasound-assisted-thrombolysis-for-submassive-pulmonary-embolism
#4
Efthymios D Avgerinos, Abhisekh Mohapatra, Belinda Rivera-Lebron, Catalin Toma, Christopher Kabrhel, Larry Fish, Joan Lacomis, Iclal Ocak, Rabih A Chaer
BACKGROUND: Catheter-directed interventions for the treatment of patients with submassive pulmonary embolism (sPE) have shown promise in rapidly improving right-sided heart strain and preventing decompensation to massive pulmonary embolism. Among various catheter interventions, ultrasound-assisted thrombolysis (USAT) has attracted interest as potentially having more efficient lytic effect that could achieve thrombolysis faster and with a reduced lytic dose. However, based on clinical evidence, it is unclear whether USAT is superior to standard catheter-directed thrombolysis (SCDT)...
January 2018: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/29239263/percutaneous-mechanical-thrombectomy-combined-with-catheter-directed-thrombolysis-in-the-treatment-of-acute-pulmonary-embolism-and-lower-extremity-deep-venous-thrombosis-a-novel-one-stop-endovascular-strategy
#5
Bing Liu, MingYuan Liu, LiHong Yan, JunWei Yan, Jiang Wu, XueFei Jiao, MingJin Guo
Objective This study was performed to evaluate the efficacy and feasibility of percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) in patients with acute pulmonary embolism (APE) and lower extremity deep venous thrombosis (LEDVT). Methods In total, 20 consecutive patients with APE and LEDVT were prospectively selected for PMT combined with CDT. Mechanical thrombus fragmentation and aspiration using a pigtail rotation catheter followed by CDT was performed in each patient...
January 1, 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/29224661/acute-limb-ischemia
#6
Charles Gilliland, Jay Shah, Jonathan G Martin, Michael J Miller
Acute limb ischemia is technically defined as ischemia of the lower extremities lasting 14 days or less. The condition affects between 15 and 26 persons per 100,000 each year in the United States. The associated morbidity and mortality is extremely high, with 1-year mortality rates reported at over 40%. Acute limb ischemia is 20 times more common in the lower extremities than the upper extremities. Both interventional radiologists and vascular surgeons bring unique skills to the table in caring for these patients, and therefore should approach the care of these patients in a multidisciplinary manner to ensure the best outcomes for each patient...
December 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29222321/thrombectomy-and-thrombolysis-for-the-prevention-and-treatment-of-postthrombotic-syndrome
#7
REVIEW
Suresh Vedantham
Postthrombotic syndrome (PTS) is a frequent complication of lower-extremity deep vein thrombosis (DVT), occurring in approximately 40% of patients despite the use of anticoagulant therapy. PTS causes significant impairment of patients' health-related quality of life, and no evidence-based therapies have been consistently effective. Catheter-directed thrombolysis and thrombectomy have been shown to remove acute thrombus, and it has been hypothesized they could prevent or reduce PTS. However, because these procedures can be associated with complications, mainly bleeding, randomized trial data are needed to determine when they should be used...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29211671/pharmacomechanical-catheter-directed-thrombolysis-for-deep-vein-thrombosis
#8
RANDOMIZED CONTROLLED TRIAL
Suresh Vedantham, Samuel Z Goldhaber, Jim A Julian, Susan R Kahn, Michael R Jaff, David J Cohen, Elizabeth Magnuson, Mahmood K Razavi, Anthony J Comerota, Heather L Gornik, Timothy P Murphy, Lawrence Lewis, James R Duncan, Patricia Nieters, Mary C Derfler, Marc Filion, Chu-Shu Gu, Stephen Kee, Joseph Schneider, Nael Saad, Morey Blinder, Stephan Moll, David Sacks, Judith Lin, John Rundback, Mark Garcia, Rahul Razdan, Eric VanderWoude, Vasco Marques, Clive Kearon
BACKGROUND: The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome. METHODS: We randomly assigned 692 patients with acute proximal deep-vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting)...
December 7, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/29175770/catheter-based-therapies-in-acute-pulmonary-embolism
#9
Jacob Schultz, Asger Andersen, Christopher Kabrhel, Jens Erik Nielsen-Kudsk
AIMS: To provide a systematic review of catheter-based therapies of acute pulmonary embolism. METHODS AND RESULTS: Studies published in peer-reviewed journals before February 2017 were included and categorized according to the mechanism of thrombus removal: fragmentation, rheolytic therapy, aspiration or catheter-directed thrombolysis. Strengths, challenges and the level of evidence of each device were evaluated. We found 16 different catheter-based therapies for acute PE; all but one being used off-label...
November 28, 2017: EuroIntervention
https://www.readbyqxmd.com/read/29157527/catheter-directed-therapy-for-pulmonary-embolism-patient-selection-and-technical-considerations
#10
REVIEW
Bedros Taslakian, Akhilesh K Sista
Acute pulmonary embolism (PE) is the third most common cause of death among hospitalized patients. Treatment escalation beyond anticoagulation therapy is necessary in patients with cardiogenic shock and may be of benefit in select normotensive patients with right heart strain. Percutaneous catheter-based techniques (catheter-directed mechanical thrombectomy, clot maceration, and/or pharmacologic thrombolysis) as an alternative or adjunct to systemic thrombolysis can rapidly debulk central clot in patients with shock...
January 2018: Interventional cardiology clinics
https://www.readbyqxmd.com/read/29152468/dual-mechanical-thrombectomy-for-recanalization-of-a-resistant-acute-posterior-circulation-stroke
#11
Ahmet Peker, Ayça Akgoz, Ethem Murat Arsava, Mehmet Akif Topçuoglu, Anil Arat
A 71-year-old man with acute basilar artery occlusion was referred for endovascular treatment 6 hours after the onset of stroke with a Glasgow Coma Score of 3 and National Institutes of Health Stroke Scale of 27. A cerebral arteriogram revealed occlusion of the left vertebral artery proximally and thromboembolic occlusion of the basilar tip. Direct aspiration and mechanical thrombectomy with various stent retrievers failed to reconstitute arterial flow in the basilar artery. Thrombolysis in cerebral infarction 2b recanalization was achieved only after placement of double Catch Mini stent retrievers through 2 microcatheters, on both side branches of the basilar bifurcation in a kissing fashion and retrieving them simultaneously...
June 2017: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/29133351/efficacy-and-safety-outcomes-of-recanalisation-procedures-in-patients-with-acute-symptomatic-pulmonary-embolism-systematic-review-and-network-meta-analysis
#12
David Jimenez, Carlos Martin-Saborido, Alfonso Muriel, Javier Zamora, Raquel Morillo, Deisy Barrios, Frederikus A Klok, Menno V Huisman, Victor Tapson, Roger D Yusen
BACKGROUND: We aimed to review the efficacy and safety of recanalisation procedures for the treatment of PE. METHODS: We searched PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through 31 July 2015 and included randomised clinical trials that compared the effect of a recanalisation procedure versus each other or anticoagulant therapy in patients diagnosed with PE. We used network meta-analysis and multivariate random-effects meta-regression to estimate pooled differences between each intervention and meta-regression to assess the association between trial characteristics and the reported effects of recanalisation procedures versus anticoagulation...
November 13, 2017: Thorax
https://www.readbyqxmd.com/read/29132220/catheter-directed-thrombolysis-versus-standard-anticoagulation-for-acute-lower-extremity-deep-vein-thrombosis-a-meta-analysis-of-clinical-trials
#13
Yongming Lu, Linyi Chen, Jinhui Chen, Tao Tang
Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29128608/a-retrospective-comparison-of-survivors-and-non-survivors-of-massive-pulmonary-embolism-receiving-veno-arterial-extracorporeal-membrane-oxygenation-support
#14
Bennet George, Marc Parazino, Hesham R Omar, George Davis, Maya Guglin, John Gurley, Susan Smyth
INTRODUCTION: While the optimal care of patients with massive pulmonary embolism (PE) is unclear, the general goal of therapy is to rapidly correct the physiologic derangements propagated by obstructive clot. Extracorporeal membrane oxygenation (ECMO) in this setting is promising, however the paucity of data limits its routine use. Our institution expanded the role of ECMO as an advanced therapy option in the initial management of massive PE. The purpose of this project was to evaluate ECMO-treated patients with massive PE at an academic medical center and report shortterm mortality outcomes...
November 8, 2017: Resuscitation
https://www.readbyqxmd.com/read/29128156/utility-of-a-power-aspiration-based-extraction-technique-as-an-initial-and-secondary-approach-in-the-treatment-of-peripheral-arterial-thromboembolism-results-of-the-multicenter-prism-trial
#15
Richard R Saxon, James F Benenati, Corey Teigen, George L Adams, Luke E Sewall
PURPOSE: To investigate the safety and initial efficacy of XTRACT, a power aspiration-based extraction technique for treatment of peripheral arterial thromboembolism with the use of the Penumbra/Indigo system. MATERIALS AND METHODS: A total of 79 patients were enrolled: 39 (49.4%) underwent XTRACT as the initial therapy and 40 (50.6%) underwent XTRACT after failed catheter-directed thrombolysis or other mechanical intervention or for removal of distal emboli that occurred during an intervention...
November 9, 2017: Journal of Vascular and Interventional Radiology: JVIR
https://www.readbyqxmd.com/read/29112470/safety-and-efficacy-of-catheter-directed-therapies-as-a-supplement-to-surgical-decompression-in-venous-thoracic-outlet-syndrome
#16
Omar Zurkiya, Dean M Donahue, T Gregory Walker, Suvranu Ganguli
OBJECTIVE: The purpose of this study is to evaluate the role of endovascular therapy in the management of venous thoracic outlet syndrome (TOS), with an emphasis on its role after surgical decompression. MATERIALS AND METHODS: This single-center retrospective review identified all patients who underwent conventional contrast-enhanced venography as a component of the imaging evaluation of clinically suspected venous TOS from January 2004 through September 2015. Eighty-one patients were identified, with a mean (± SD) age of 33 ± 12 years, of whom 59% (48/81) were women...
November 7, 2017: AJR. American Journal of Roentgenology
https://www.readbyqxmd.com/read/29073366/catheter-directed-thrombolysis-for-intermediate-risk-pulmonary-embolism
#17
David Furfaro, R Scott Stephens, Michael B Streiff, Roy Brower
Intermediate risk pulmonary embolism is common and carries a risk of progression to hemodynamic collapse and death. Catheter directed thrombolysis is an increasingly utilized treatment option, based largely on the assumptions that it is more efficacious than anticoagulation alone, and safer than systemic thrombolysis. In this review, we critically analyze the published data regarding catheter directed thrombolysis for the treatment of intermediate risk pulmonary embolism. Catheter directed thrombolysis reduces right heart strain and lowers pulmonary artery pressures more quickly than anticoagulation alone...
October 26, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/29070134/-comparison-of-therapeutic-efficacy-of-anticoagulation-and-its-combination-with-catheter-directed-thrombolysis-for-deep-venous-thrombosis-of-lower-extremities
#18
Shao-Fei Su, Yu-Feng Tian, Lin-Bao Chen, Bo Yan
OBJECTIVE: To investigate the therapeutic efficacy of anticoagulation(AC) and its combination with catheter-directed thrombolysis(CDT) for deep venous thrombosis of lower extremities. METHODS: One hundred and thirty-nine patients with deep venous thrombosis of early lower extremities treated in our hospital from May 2011 to September 2013 were selected and randomly divided into the AC group(n= 66) and CDT+AC group(n= 73). The thrombolytic effects, adverse reactions, post-thrombotic syndrome (PTS) and quality of life were evaluated...
October 2017: Zhongguo Shi Yan Xue Ye Xue za Zhi
https://www.readbyqxmd.com/read/29068112/use-of-systemic-bivalirudin-with-catheter-directed-thrombolysis-in-a-patient-with-heparin-induced-thrombocytopenia-a-case-report
#19
Hisham A Badreldin, Jessica Rimsans, Jean M Connors, Stephen D Wiviott
In patients with submassive pulmonary embolism, the use of catheter-directed thrombolysis (CDT), using low-dose alteplase is associated with improvement in overall hemodynamics. The data for use of CDT in patients with heparin-induced thrombocytopenia are limited. We report a case of CDT in a patient with HIT using bivalirudin anticoagulation. Data of the use of bivalirudin and argatroban for systemic anticoagulation with CDT are limited.
October 25, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29058996/successful-use-of-extracorporeal-membrane-oxygenation-in-a-child-with-obstructive-shock-due-to-massive-bilateral-pulmonary-embolism
#20
Aditya Badheka, Pradeep Bangalore Prakash, Veerajalandhar Allareddy
BACKGROUND: Acute massive pulmonary embolism (PE) is a very rare condition in children. We report the successful use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a lifesaving modality in a child with acute massive PE. CASE PRESENTATION: A nine-year-old female with spinal muscular atrophy type 1, chronic respiratory failure with tracheostomy and ventilator dependence presented with tachypnea and hypoxia. She had recent coiling of her pulmonary arterio-venous malformation...
October 1, 2017: Perfusion
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