Lin Peter H, Chen Huiting, Bechara Carlos F, Kougias Panagiotis
Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Perspect Vasc Surg Endovasc Ther. 2010 Sep;22(3):171-82. doi: 10.1177/1531003510379880.
Massive pulmonary embolism (PE) is a highly lethal condition with clinical manifestations of hemodynamic instability, acute right ventricular (RV) failure, and cardiogenic shock. Submassive PE, as defined by RV failure or troponin elevation, can result in life-threatening sequelae if treatment is not initiated promptly. Current treatment paradigm in patients with massive PE mandates prompt risk stratification with aggressive therapeutic strategies. With the advent of endovascular technologies, various catheter-based thrombectomy and thrombolytic devices are available to treat patients with massive or submassive PE. In this article, a variety of endovascular treatment strategies for PE are analyzed. The authors' institutional experience with ultrasound-accelerated thrombolytic therapy as well as catheter-directed thrombolytic therapy in patients with acute massive PE during a recent 10-year period is discussed. Finally, clinical evidence on the utilization of catheter-based interventions in patients with massive and submassive PE is also analyzed.
大面积肺栓塞（PE）是一种具有血流动力学不稳定、急性右心室（RV）衰竭和心源性休克临床表现的高度致死性疾病。根据右心室衰竭或肌钙蛋白升高定义的次大面积PE，如果不及时开始治疗，可能会导致危及生命的后遗症。目前，大面积PE患者的治疗模式要求通过积极的治疗策略进行快速风险分层。随着血管内技术的出现，各种基于导管的血栓切除术和溶栓装置可用于治疗大面积或次大面积PE患者。在本文中，分析了多种PE的血管内治疗策略。讨论了作者所在机构在最近10年期间对急性大面积PE患者进行超声加速溶栓治疗以及导管定向溶栓治疗的经验。最后，还分析了在大面积和次大面积PE患者中使用基于导管的干预措施的临床证据。
