Mostafa Ashraf, Briasoulis Alexandros, Telila Tesfaye, Belgrave Kevin, Grines Cindy
Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Department of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Am J Cardiol. 2016 Mar 15;117(6):1014-20. doi: 10.1016/j.amjcard.2015.12.041. Epub 2015 Dec 31.
The presentation of acute pulmonary thromboembolism (PE) can be highly variable resulting in diagnostic challenges and management difficulties. Current guidelines suggest that therapy must be adjusted based on the severity of PE presentation. Systemic thrombolysis is the standard therapy for acute massive PE; however, systemic thrombolysis carries an estimated 20% risk of major hemorrhage, including a 3% to 5% risk of hemorrhagic stroke. There are data supporting the use of catheter-directed therapy (CDT) in massive and submassive PE, but past studies have limited its use to patients in whom systemic thrombolysis has either failed or was contraindicated. There is a paucity of data comparing the efficacy of CDT compared to systemic thrombolysis in different risk groups. This review will summarize the available data on the techniques and indications and outcomes of CDT for acute PE.
急性肺血栓栓塞症（PE）的表现可能高度多变，导致诊断困难和管理难题。当前指南建议，必须根据PE表现的严重程度调整治疗方案。全身溶栓是急性大面积PE的标准治疗方法；然而，全身溶栓估计有20%的大出血风险，包括3%至5%的出血性中风风险。有数据支持在大面积和次大面积PE中使用导管定向治疗（CDT），但过去的研究将其使用局限于全身溶栓失败或禁忌的患者。比较不同风险组中CDT与全身溶栓疗效的数据很少。本综述将总结关于急性PE的CDT技术、适应证和结果的现有数据。
