Rousseau Hervé, Del Giudice Costantino, Sanchez Olivier, Ferrari Emile, Sapoval Marc, Marek Pierre, Delmas Clément, Zadro Charline, Revel-Mouroz Paul
Service d'imagerie CHU Toulouse, Rangueil, France.
Service de Radiologie interventionnelle HEGP Paris, France.
Heliyon. 2021 Apr 1;7(4):e06574. doi: 10.1016/j.heliyon.2021.e06574. eCollection 2021 Apr.
The aim of this article is to define the place of new endovascular methods for the management of pulmonary embolisms (PE), on the basis of a multidisciplinary consensus.
Briefly, from the recent literature, for high-risk PE presenting with shock or cardiac arrest, systemic thrombolysis or embolectomy is recommended, while for lowrisk PE, anticoagulation alone is proposed. Normo-tense patients with PE but with biological or imaging signs of right heart dysfunction constitute a group known as "at intermediate risk" for which the therapeutic strategy remains controversial. In fact, some patients may require more aggressive treatment in addition to the anticoagulant treatment, because approximately 10% will decompensate hemodynamically with a high risk of mortality. Systemic thrombolysis may be an option, but with hemorrhagic risks, particularly intra cranial. Various hybrid pharmacomechanical approaches are proposed to maintain the benefits of thrombolysis while reducing its risks, but the overall clinical experience of these different techniques remains limited. Patients with high intermediate and high risk pulmonary embolism should be managed by a multidisciplinary team combining the skills of cardiologists, resuscitators, pneumologists, interventional radiologists and cardiac surgeons. Such a team can determine which intervention - thrombolysis alone or assisted, percutaneous mechanical fragmentation of the thrombus or surgical embolectomy - is best suited to a particular patient.
This consensus document define the place of endovascular thrombectomy based on an appropriate risk stratification of PE.
本文旨在通过多学科共识确定新的血管内方法在肺栓塞（PE）治疗中的地位。
简而言之，从近期文献来看，对于伴有休克或心脏骤停的高危PE，推荐进行全身溶栓或栓子切除术；而对于低危PE，建议仅进行抗凝治疗。血压正常但有生物标志物或影像学证据显示右心功能不全的PE患者构成了一个被称为“中危”的群体，其治疗策略仍存在争议。事实上，一些患者除抗凝治疗外可能还需要更积极的治疗，因为约10%的患者会出现血流动力学失代偿，死亡风险很高。全身溶栓可能是一种选择，但存在出血风险，尤其是颅内出血风险。人们提出了各种混合药物机械方法，以在维持溶栓益处的同时降低其风险，但这些不同技术的总体临床经验仍然有限。中高危肺栓塞患者应由一个多学科团队管理，该团队整合心脏病专家、复苏专家、呼吸科医生、介入放射科医生和心脏外科医生的技能。这样的团队可以确定哪种干预措施——单独溶栓或辅助溶栓、经皮血栓机械破碎或外科栓子切除术——最适合特定患者。
本共识文件基于对PE的适当风险分层确定了血管内血栓切除术的地位。
