Cardiac and Vascular Center, Semmelweis University, Városmajor str 68, 1122 Budapest, Hungary.
Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of Szent-Györgyi Albert Medical University, Kecskemét, Hungary.
Cardiol J. 2020;27(4):368-375. doi: 10.5603/CJ.a2020.0060. Epub 2020 Apr 24.
Catheter directed thrombolysis (CDT) and thrombectomy represent well established techniques for the treatment of intermediate pulmonary embolism (IPE). The long-term effect of catheter directed thrombolysis of IPE is unknown.
Clinical, interventional and echocardiographic data from 80 consecutive patients with IPE who were treated with CDT were evaluated. Primary end-points were technical success and major adverse events. Secondary end-points were cardiovascular mortality, all-cause mortality, clinical success, rate of bleeding complications, improvement in pulmonary pressure and echocardiography parameters. CDT completed with alteplase (10 mg bolus and 1 mg/h maintenance dose) through a pig-tail catheter for 24 h. After 24 h, control pulmonary angiography was performed.
In total, 80 patients with a mean age of 59.0 ± 16.8 years were treated. CDT was successful after the first post-operative day in 72 (90%) patients, but thrombus aspiration and fragmentation was performed due to failed thrombolysis in 8 (10%) patients. Final technical and clinical success was reached in 79 (98.8%) and 77 (96.3%) patients, respectively. The mean CDT time in IPE was 27.8 ± 9.6 h. Invasive pulmonary pressure dropped from 57.5 ± 16.7 to 38.9 ± 13.5 (p < 0.001). A caval filter was implanted in 4 (5%) patients. The 1-year major adverse events and cardiovascular mortality rate was 4.0% and 1.4%, respectively. Access site complications (6 major and 6 minor) were encountered in 12 (16.2%) patients.
Catheter directed thrombolysis in submassive pulmonary embolism had excellent results. However, additional mechanical thrombectomy was necessary in some patients to achieve good clinical outcomes.
导管定向溶栓（CDT）和血栓切除术是治疗中等程度肺栓塞（IPE）的成熟技术。IPE 导管定向溶栓的长期效果尚不清楚。
评估了 80 例接受 CDT 治疗的 IPE 患者的临床、介入和超声心动图数据。主要终点为技术成功率和主要不良事件。次要终点为心血管死亡率、全因死亡率、临床成功率、出血并发症发生率、肺动脉压和超声心动图参数改善。通过猪尾导管在 24 小时内用阿替普酶（10mg 推注和 1mg/h 维持剂量）完成 CDT。24 小时后，进行控制肺动脉造影。
共治疗 80 例患者，平均年龄为 59.0±16.8 岁。72 例（90%）患者在术后第 1 天即成功完成 CDT，但 8 例（10%）患者因溶栓失败而进行血栓抽吸和碎裂。最终技术和临床成功率分别达到 79（98.8%）和 77（96.3%）例。IPE 中 CDT 的平均时间为 27.8±9.6 小时。侵入性肺动脉压从 57.5±16.7mmHg 降至 38.9±13.5mmHg（p<0.001）。4 例（5%）患者植入腔静脉滤器。1 年时主要不良事件和心血管死亡率分别为 4.0%和 1.4%。12 例（16.2%）患者出现 12 例（6 例主要、6 例次要）入路部位并发症。
在亚大面积肺栓塞中，导管定向溶栓效果良好。然而，为了获得良好的临床结果，一些患者需要额外的机械血栓切除术。
