Bremer William, Ray Charles E, Shah Ketan Y
University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
Semin Intervent Radiol. 2020 Mar;37(1):62-73. doi: 10.1055/s-0039-3401841. Epub 2020 Mar 4.
Pulmonary embolism is a common cause of morbidity and mortality which continues to increase in overall incidence. Because it can occur with a wide range of clinical presentations, different guidelines have been developed for appropriate risk stratification of patients; interventional radiology plays a vital role in the management of both massive and submassive pulmonary embolism. Catheter-directed therapy, including mechanical and aspiration thrombectomy, standard catheter-directed thrombolysis, and ultrasound-accelerated thrombolysis, has many benefits, including lower thrombolytic doses and intraclot administration of thrombolytic therapy. While the role of catheter-directed therapy is still being developed, four important prospective studies have demonstrated its safety and efficacy. Additional studies comparing short- and long-term clinical outcomes in patients treated with catheter-directed therapy versus anticoagulation are the next step in understanding its role within the management of submassive pulmonary embolism. Furthermore, multidisciplinary pulmonary embolism response teams, in which interventional radiology plays a crucial role, are becoming essential to appropriately managing pulmonary embolism patients, including selection of those who may benefit from catheter-directed therapy.
肺栓塞是发病率和死亡率的常见原因，其总体发病率持续上升。由于它可能出现多种临床表现，因此已制定了不同的指南用于对患者进行适当的风险分层；介入放射学在大面积和次大面积肺栓塞的管理中起着至关重要的作用。导管定向治疗，包括机械血栓清除术、抽吸血栓清除术、标准导管定向溶栓和超声加速溶栓，有许多益处，包括较低的溶栓剂量和在血栓内给药溶栓治疗。虽然导管定向治疗的作用仍在发展中，但四项重要的前瞻性研究已证明了其安全性和有效性。下一步是进行更多研究，比较接受导管定向治疗与抗凝治疗的患者的短期和长期临床结果，以了解其在次大面积肺栓塞管理中的作用。此外，多学科肺栓塞反应团队，其中介入放射学起着关键作用，对于妥善管理肺栓塞患者，包括选择可能从导管定向治疗中获益的患者，正变得至关重要。
