Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713.
Department of Vascular and Interventional Radiology, Christiana Care Health System, 4755 Ogletown Stanton Road, Suite 1e20, Newark, DE 19713.
J Vasc Interv Radiol. 2020 Dec;31(12):2052-2059. doi: 10.1016/j.jvir.2020.08.028. Epub 2020 Nov 9.
To compare effectiveness and safety of large-bore aspiration thrombectomy (LBAT) with catheter-directed thrombolysis (CDT) for treatment of acute massive and submassive pulmonary embolism (PE).
This retrospective review included patients with acute PE treated with LBAT or CDT using tissue plasminogen activator (tPA) between December 2009 and May 2020. A propensity score based on Pulmonary Embolism Severity Index class and PE severity (massive vs submassive) was calculated, and 26 LBAT cases (age 60.2 y ± 17.1, 14/26 women) were matched with 26 CDT cases (age 59.7 y ± 14.2, 14/26 women).
The CDT group had 22.1 mg ± 8.1 tPA infused over 21.2 h ± 6.6. Both groups demonstrated similar initial and final systolic pulmonary artery pressure (PAP) (LBAT: 54.5 mm Hg ± 12.9 vs CDT: 54.5 mm Hg ± 16.3, P = .8, and LBAT: 42.5 mm Hg ± 14.1 vs CDT: 42.6 mm Hg ± 12.1, P = .8, respectively) and similar reductions in heart rate (LBAT: -5.4 beats/min ± 19.2 vs CDT: -9.6 beats/min ± 15.8, P = .4). CDT demonstrated a higher reduction in Miller score (-10.1 ± 3.9 vs -7.5 ± 3.8, P = .02). LBAT resulted in 1 minor hemorrhagic complication and 2 procedure-related mortalities, and CDT resulted in 1 minor and 1 major hemorrhagic complication.
LBAT and CDT resulted in similar reductions of PAP and heart rate when used to treat acute PE. CDT reduced thrombus burden to a greater degree. Although hemorrhagic complications rates were not significantly different, the LBAT group demonstrated a higher rate of procedure-related mortality. Larger studies are needed to compare the safety of these techniques.
比较大口径抽吸血栓切除术（LBAT）与导管直接溶栓（CDT）治疗急性大块和次大块肺栓塞（PE）的疗效和安全性。
本回顾性研究纳入了 2009 年 12 月至 2020 年 5 月期间接受 LBAT 或 CDT 联合组织型纤溶酶原激活剂（tPA）治疗的急性 PE 患者。采用基于肺栓塞严重程度指数（PESI）分级和 PE 严重程度（大块与次大块）的倾向评分匹配了 26 例 LBAT 患者（年龄 60.2 岁±17.1 岁，14/26 例女性）与 26 例 CDT 患者（年龄 59.7 岁±14.2 岁，14/26 例女性）。
CDT 组输注 tPA 剂量为 22.1 mg±8.1 mg，输注时间为 21.2 h±6.6 h。两组患者初始和终末收缩期肺动脉压（PAP）均无显著差异（LBAT：54.5 mm Hg±12.9 与 CDT：54.5 mm Hg±16.3，P=0.8；LBAT：42.5 mm Hg±14.1 与 CDT：42.6 mm Hg±12.1，P=0.8），心率下降幅度也相似（LBAT：-5.4 次/分±19.2 与 CDT：-9.6 次/分±15.8，P=0.4）。CDT 组 Miller 评分下降幅度更大（-10.1±3.9 与-7.5±3.8，P=0.02）。LBAT 组发生 1 例轻微出血性并发症和 2 例与操作相关的死亡，CDT 组发生 1 例轻微出血性并发症和 1 例大出血性并发症。
LBAT 和 CDT 治疗急性 PE 时均可使 PAP 和心率显著降低，而 CDT 降低血栓负荷的程度更大。虽然出血性并发症发生率无显著差异，但 LBAT 组与操作相关的死亡率更高。需要开展更大规模的研究比较这两种技术的安全性。
