Graif Assaf, Grilli Christopher J, Kimbiris George, Agriantonis Demetrios J, Chohan Omar Z, Fedele Charles R, Gakhal Mandip S, Vance Ansar Z, Leung Daniel A
Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd., P.O. Box 6001, Newark, DE 19713.
Department of Radiology, Christiana Care Health System, 4755 Ogletown Stanton Rd., P.O. Box 6001, Newark, DE 19713.
J Vasc Interv Radiol. 2017 Oct;28(10):1339-1347. doi: 10.1016/j.jvir.2017.07.004. Epub 2017 Aug 18.
To compare the technical and clinical effectiveness of ultrasound-accelerated endovascular thrombolysis (USAT) versus pigtail catheter-directed thrombolysis (PCDT) for the treatment of acute pulmonary embolism (PE).
A single-center retrospective study of patients treated with USAT or PCDT for acute massive or submassive PE between January 2010 and December 2016 was performed by reviewing electronic medical records. Sixty treatments were reviewed (mean patient age, 56.7 y ± 14.6), including 52 cases of submassive PE (21 treated with USAT, 31 with PCDT) and 8 cases of massive PE (3 treated with USAT, 5 with PCDT). Endpoints included pulmonary artery pressure (PAP), Miller PE severity index, tissue plasminogen activator (TPA) dose, infusion duration, procedural variables, and complications.
Demographics, PE severity, and right:left ventricular diameter ratios were similar between groups. USAT and PCDT significantly reduced mean PAP (reductions of 7.4 mm Hg [P = .002] and 8.2 mm Hg [P < .001], respectively) and Miller index scores (reductions of 45.8% [P < .001] and 53% [P < .001], respectively) with similar effectiveness (P = .47 and P = .15, respectively). Procedure (P < .001) and fluoroscopy (P = .001) times were significantly longer in the USAT group. The USAT group underwent fewer sessions (2.2 ± 0.6 vs 2.4 ± 0.6; P = .17) with shorter infusion times (23.9 h ± 8.8 vs 30.4 h ± 12.6; P = .065) and a lower total dose of TPA (27.1 mg ± 11.3 vs 30.4 mg ± 12.6; P = .075) compared with the PCDT group, but the differences were not significant. Complications (P = .07) and 30-day mortality rates (P = .56) were not significantly different between groups.
USAT and PCDT demonstrated comparable effectiveness and safety in the treatment of patients with acute PE.
比较超声加速血管内溶栓（USAT）与猪尾导管直接溶栓（PCDT）治疗急性肺栓塞（PE）的技术及临床效果。
通过回顾电子病历，对2010年1月至2016年12月期间接受USAT或PCDT治疗急性大面积或次大面积PE的患者进行单中心回顾性研究。共回顾了60例治疗病例（患者平均年龄56.7岁±14.6岁），其中包括52例次大面积PE（21例接受USAT治疗，31例接受PCDT治疗）和8例大面积PE（3例接受USAT治疗，5例接受PCDT治疗）。观察指标包括肺动脉压（PAP）、米勒PE严重程度指数、组织纤溶酶原激活剂（TPA）剂量、输注持续时间、操作变量及并发症。
两组患者的人口统计学特征、PE严重程度及左右心室直径比相似。USAT和PCDT均显著降低了平均PAP（分别降低7.4 mmHg [P = 0.002]和8.2 mmHg [P < 0.001]）及米勒指数评分（分别降低45.8% [P < 0.001]和53% [P < 0.001]），效果相似（分别为P = 0.47和P = 0.15）。USAT组的操作时间（P < 0.001）和透视时间（P = 0.001）显著更长。与PCDT组相比，USAT组的治疗次数更少（2.2 ± 0.6 vs 2.4 ± 0.6；P = 0.17），输注时间更短（23.9 h ± 8.8 vs 30.4 h ± 12.6；P = 0.065），TPA总剂量更低（27.1 mg ± 11.3 vs 30.4 mg ± 12.6；P = 0.075），但差异均无统计学意义。两组的并发症（P = 0.07）及30天死亡率（P = 0.56）无显著差异。
USAT和PCDT在治疗急性PE患者方面显示出相当的有效性和安全性。
