Department of Interventional Radiology, Holmes Regional Medical Center, Melbourne, FL 32901, USA.
J Vasc Interv Radiol. 2013 Jun;24(6):841-8. doi: 10.1016/j.jvir.2013.02.023. Epub 2013 Apr 16.
To evaluate retrospectively the safety profile and clinical success of ultrasound-accelerated thrombolysis for acute pulmonary embolism (PE) with a standard lytic infusion protocol.
A retrospective study was performed at a single center treating patients with acute PE between October 2009 and April 2012. On diagnosis of submassive or massive PE by pulmonary computed tomography angiography or ventilation/perfusion scan, all patients received anticoagulation and treatment using the EkoSonic endovascular system (EKOS Corporation, Bothell, Washington). The ultrasound-accelerated thrombolytic infusion catheters were placed into the affected pulmonary arteries to facilitate administration of recombinant tissue plasminogen activator at 0.5-1.0mg/h/catheter.
Treatment of 60 patients (35 men, 25 women; age 61 y±16; 53 bilateral PE; 48 submassive PE) resulted in complete thrombus clearance (≥90%) in 57% and near-complete (50%-90%) clearance in 41% of patients after infusion of 35.1 mg±11.1 of recombinant tissue plasminogen activator over 19.6 hours±6.0. Measurements before and after treatment showed a decrease in pulmonary artery pressure (47 mm Hg±15 to 38 mm Hg±12 [systolic], P<.001) and Miller score (25±3 to 17±6, P<.001). There were 57 patients who survived to discharge. All three patients who died in the hospital presented with massive PE. On 90-day follow-up, 56 patients (93%) were alive.
The current study demonstrates effectiveness and safety of ultrasound-accelerated thrombolysis in patients with acute PE with a large thrombus burden.
通过标准溶栓方案评估超声加速溶栓治疗急性肺栓塞（PE）的安全性和临床疗效。
在 2009 年 10 月至 2012 年 4 月期间，对一家单中心的急性 PE 患者进行了回顾性研究。在通过肺 CT 血管造影或通气/灌注扫描诊断为亚大块或大块 PE 后，所有患者均接受抗凝治疗，并使用 EkoSonic 血管内系统（EKOS 公司，华盛顿州博塞尔）进行治疗。将超声加速溶栓输注导管放置在受影响的肺动脉中，以便以 0.5-1.0mg/h/导管的速度给予重组组织纤溶酶原激活剂。
60 例患者（35 例男性，25 例女性；年龄 61 岁±16 岁；53 例双侧 PE；48 例亚大块 PE）接受治疗后，有 57%的患者完全清除血栓（≥90%），41%的患者接近完全清除（50%-90%）。在输注 35.1mg±11.1 重组组织纤溶酶原激活剂 19.6 小时±6.0 后。治疗前后的测量值显示肺动脉压（47mmHg±15 降至 38mmHg±12[收缩压]，P<.001）和 Miller 评分（25±3 降至 17±6，P<.001）均降低。有 57 例患者存活至出院。在医院死亡的 3 例患者均为大块 PE。90 天随访时，56 例患者（93%）存活。
本研究表明，对于大块血栓负荷的急性 PE 患者，超声加速溶栓治疗是有效且安全的。
