Hassan Ayman K M, Ahmed Heba, Ahmed Yousef, Elfadl Abd-Elazim Abo, Omar Amany
Cardiology Department, Assiut University, P.Box: 71526, Asyut, Egypt.
Chest Department, Assiut University, Asyut, Egypt.
Egypt Heart J. 2021 Sep 25;73(1):84. doi: 10.1186/s43044-021-00204-2.
Pulmonary embolism (PE) is the third most common acute cardiovascular syndrome. Percutaneous catheter directed hydro-mechanical defragmentation (HMD) is one of the recommended treatment options for PE in patients with contraindications to thrombolytic therapy or failed systemic thrombolysis (ST). We aimed to identify the safety and outcomes of catheter directed HMD in patients with high-risk PE. This nonrandomized controlled trial enrolled all patients with confirmed diagnoses of high- and intermediate-high-risk PE from October 2019 till January 2021. Fifty patients were included and divided into two groups by the PE response team according to the presence or absence of a contraindication for ST. Group B (ST) consists of 25 patients and group A (HMD) of 25 patients who cannot receive ST.
The two groups were comparable regarding baseline clinical characteristics with mean age 51 ± 13 years. In group A, systolic blood pressure (BP) and oxygen saturation increased after 24 h (p = 0.002) and 48 h (p < 0.001) compared to pre-HMD procedure. Mean pulmonary artery systolic pressure (PASP) and respiratory rate (RR) decreased after 48 h and at 30 days (p < 0.001) compared to pre-HMD procedure. The increase in systolic BP and oxygen saturation were significantly higher in HMD group compared with ST group after 48 h and at 30 days (p < 0.007). The decrease in PASP and RR was significantly higher in HMD group compared to ST group after 48 h and at 30 days (p < 0.001). Mortality rate at 30 days was 20% in HMD group compared to 32% in ST group.
Catheter directed HMD for high-risk and intermediate-high-risk PE is safe and effective with acceptable mortality Trial registration Clinical trial ID: NCT04099186.
肺栓塞（PE）是第三常见的急性心血管综合征。经皮导管定向水力机械血栓清除术（HMD）是溶栓治疗禁忌或全身溶栓（ST）失败的PE患者推荐的治疗选择之一。我们旨在确定导管定向HMD治疗高危PE患者的安全性和疗效。这项非随机对照试验纳入了2019年10月至2021年1月期间所有确诊为高危和中高危PE的患者。共纳入50例患者，由PE反应小组根据是否存在ST禁忌将其分为两组。B组（ST组）由25例患者组成，A组（HMD组）由25例不能接受ST的患者组成。
两组基线临床特征具有可比性，平均年龄为51±13岁。在A组中，与HMD术前相比，收缩压（BP）和血氧饱和度在术后24小时（p = 0.002）和48小时（p < 0.001）升高。与HMD术前相比，平均肺动脉收缩压（PASP）和呼吸频率（RR）在术后48小时和30天时降低（p < 0.001）。术后48小时和30天时，HMD组收缩压和血氧饱和度的升高显著高于ST组（p < 0.007）。术后48小时和30天时，HMD组PASP和RR的降低显著高于ST组（p < 0.001）。HMD组30天死亡率为20%，而ST组为32%。
导管定向HMD治疗高危和中高危PE安全有效，死亡率可接受。试验注册号：临床试验ID：NCT04099186。
