McCabe James M, Huang Pei-Hsiu, Riedl Lauren, Eisenhauer Andrew C, Sobieszczyk Piotr
Division of Cardiology, University of Washington, Seattle, Washington.
Sutter Heart and Vascular Institute, Sacramento, California.
Am J Cardiol. 2015 Mar 15;115(6):821-4. doi: 10.1016/j.amjcard.2014.12.050. Epub 2015 Jan 7.
The optimal treatment for intermediate-risk pulmonary embolism (PE) remains unclear. Our goal was to describe the safety and efficacy of the EkoSonic ultrasound-assisted catheter-directed thrombolysis system (EKOS Corporation, Bothell, Washington) in a real-world registry of patients with intermediate-risk PE. Fifty-three consecutive patients with intermediate-risk PE treated with ultrasound-assisted catheter-directed thrombolysis at Brigham and Women's Hospital from 2010 to 2014 were analyzed. The primary outcome was a change in directly measured pulmonary artery pressures as assessed using logistic regression with generalized estimating equations to account for serial measurements. Patients received an average of 24.6 ± 9 mg of alteplase using the EKOS catheter with an average treatment time of 15.9 ± 3 hours. After treatment, there was a 7.2- and a 11.4-mm Hg reduction in mean and systolic pulmonary artery pressure (95% confidence interval 4.7 to 9.7 mm Hg, p <0.001, and 95% confidence interval 7.8 to 15.0 mm Hg, p <0.001), respectively. In this cohort, 9.4% had any bleeding complication noted during their hospital stay. One patient's alteplase was prematurely discontinued for access site bleeding although no other interventions were required related to bleeding complications.
中危肺栓塞（PE）的最佳治疗方法仍不明确。我们的目标是在一个中危PE患者的真实世界登记研究中，描述EkoSonic超声辅助导管定向溶栓系统（EKOS公司，华盛顿州博塞尔）的安全性和有效性。对2010年至2014年在布莱根妇女医院接受超声辅助导管定向溶栓治疗的53例连续中危PE患者进行了分析。主要结局是使用广义估计方程的逻辑回归评估直接测量的肺动脉压力的变化，以考虑系列测量。患者使用EKOS导管平均接受了24.6±9mg的阿替普酶，平均治疗时间为15.9±3小时。治疗后，平均肺动脉压和收缩期肺动脉压分别降低了7.2和11.4mmHg（95%置信区间4.7至9.7mmHg，p<0.001，以及95%置信区间7.8至15.0mmHg，p<0.001）。在该队列中，9.4%的患者在住院期间出现了任何出血并发症。1例患者因穿刺部位出血提前停用了阿替普酶，不过未因出血并发症进行其他干预。
