急性不稳定型肺栓塞患者的导管定向抽吸血栓切除术和低剂量溶栓治疗：来自肺栓塞登记处的前瞻性结局。

Catheter-directed aspiration thrombectomy and low-dose thrombolysis for patients with acute unstable pulmonary embolism: Prospective outcomes from a PE registry.

机构信息

Interventional Radiology, Hospital Clinico Universitario Lozano Blesa, Gómez Laguna 18, 50009 Zaragoza, Spain; GITMI (Group of Research in Minimally Invasive Techniques), University of Zaragoza, Domingo Miral s/n, Zaragoza, Spain.

Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, CA, United States.

出版信息

Int J Cardiol. 2019 Jul 15;287:106-110. doi: 10.1016/j.ijcard.2019.02.061. Epub 2019 Feb 28.

DOI:10.1016/j.ijcard.2019.02.061

PMID:30846255

Abstract

OBJECTIVES

To evaluate the efficacy and safety of aspiration thrombectomy in combination with low-dose catheter-directed thrombolysis for acute unstable pulmonary embolism (PE).

BACKGROUND

Acute unstable (PE) is a life-threatening condition requiring treatment escalation, but many patients cannot receive full-dose systemic thrombolysis due to contraindications.

METHODS

Eligible patients had a PE with sustained hypotension. We used a 115-cm, 8-F continuous aspiration mechanical thrombectomy catheter to perform mechanical thrombectomy, followed by catheter-directed thrombolysis with low-dose urokinase. The primary efficacy outcome was the change in the pulmonary artery pressure after aspiration thrombectomy and catheter-directed thrombolysis. Secondary efficacy outcomes were stabilization of hemodynamics post-procedure and survival to hospital discharge. The primary safety outcome was major procedure-related complications and major bleeding events.

RESULTS

We included 54 patients with acute unstable PE. After thrombectomy, mean systolic pulmonary artery pressure decreased from 60.2 mm Hg to 55.2 mm Hg (P < 0.01), and to 40.5 mm Hg after catheter thrombolysis (P < 0.0001). The in-hospital PE-related death occurred in six patients (11%; 95% confidence interval [CI], 4.2-23%) at a mean follow-up of 1.1 days, and hemodynamics stabilized in the remaining 48 patients. Minor complications after thrombectomy included arrhythmias (4 of 48 patients, 8.3%; 95% CI, 2.3-20%), and minor bleeding episodes (3 of 48 patients; 6.2%; 95% CI, 1.3-17%). Major complication occurred in one patient (2.1%; 95% CI, 0.1-11%) who developed hemorrhagic transformation of paradoxical embolic stroke following catheter-directed thrombolysis.

CONCLUSIONS

Aspiration thrombectomy followed by catheter-directed thrombolysis was overall effective and safe in treating patients with acute unstable PE.

摘要

目的

评估抽吸血栓切除术联合小剂量导管溶栓治疗急性不稳定型肺栓塞（PE）的疗效和安全性。

背景

急性不稳定型（PE）是一种危及生命的病症，需要升级治疗，但由于存在禁忌证，许多患者无法接受全剂量全身溶栓治疗。

方法

符合条件的患者患有持续低血压的 PE。我们使用 115cm、8F 的连续抽吸机械血栓切除术导管进行机械血栓切除术，然后进行小剂量尿激酶导管溶栓。主要疗效终点是抽吸血栓切除术后和导管溶栓后的肺动脉压变化。次要疗效终点是术后血流动力学稳定和存活至出院。主要安全性终点是主要与手术相关的并发症和主要出血事件。

结果

我们纳入了 54 例急性不稳定型 PE 患者。血栓切除术后，平均收缩压肺动脉压从 60.2mmHg 降至 55.2mmHg（P<0.01），导管溶栓后降至 40.5mmHg（P<0.0001）。6 例患者（11%；95%置信区间[CI]，4.2-23%）在平均 1.1 天的随访中发生院内与 PE 相关的死亡，其余 48 例患者血流动力学稳定。血栓切除术后的轻微并发症包括心律失常（48 例患者中有 4 例，8.3%；95%CI，2.3-20%）和轻微出血事件（48 例患者中有 3 例，6.2%；95%CI，1.3-17%）。1 例患者（2.1%；95%CI，0.1-11%）发生导管溶栓后出现矛盾性栓塞性卒中的出血性转化这一重大并发症。