Luedemann Willie M, Collettini Federico, Fehrenbach Uli, Auer Timo, de Bucourt Maximilian, Gebauer Bernhard
Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany.
Eur Radiol. 2025 May 9. doi: 10.1007/s00330-025-11548-7.
Catheter-based recanalization procedures have long been standard of care in treating myocardial infarction and stroke. Interventional treatments for pulmonary embolism (PE), however, have only been performed occasionally as second-line strategies until recently. Current guidelines still recommend systemic thrombolysis, which may halve the mortality risk in patients with high-risk pulmonary embolism but is underused outside experienced centers. Novel devices for thrombectomy have significantly changed clinical practice and potentially fill a treatment gap in intermediate and high-risk pulmonary embolism. Observational data are encouraging and randomized controlled trials are underway to prove safety and efficacy, which requires the adaptation of current treatment paradigms. Interdisciplinary pulmonary embolism response teams are needed to provide individualized care, and interventional radiologists are suited to play a pivotal role given their expertise in both diagnostic imaging and invasive procedures. To live up to this challenge, interventional radiologists must familiarize themselves with both the pathophysiology of acute PE as well as with the principles of care provided by other team members. KEY POINTS: Question The recommended treatment of high-risk pulmonary embolism is systemic thrombolysis. New devices for percutaneous aspiration thrombectomy aim to change treatment paradigms and need critical review. Findings Observational data suggests both safety and efficacy of novel thrombectomy devices, randomized controlled trials are underway. The added value of catheter-directed thrombolysis is unclear. Clinical relevance Systemic thrombolysis reduces mortality in patients with high-risk pulmonary embolism but is disproportionately rarely used outside of experienced centers. Percutaneous large-bore pulmonary thrombectomy holds great potential for filling a treatment gap in intermediate and high-risk pulmonary embolism and changing guidelines.
基于导管的再通程序长期以来一直是治疗心肌梗死和中风的标准治疗方法。然而，直到最近，肺栓塞（PE）的介入治疗仅偶尔作为二线策略进行。目前的指南仍推荐全身溶栓治疗，这可能会使高危肺栓塞患者的死亡风险减半，但在经验丰富的中心之外使用不足。新型血栓切除术设备已显著改变临床实践，并有可能填补中高危肺栓塞的治疗空白。观察数据令人鼓舞，随机对照试验正在进行以证明其安全性和有效性，这需要调整当前的治疗模式。需要跨学科的肺栓塞应对团队来提供个性化护理，鉴于介入放射科医生在诊断成像和侵入性操作方面的专业知识，他们适合发挥关键作用。为了应对这一挑战，介入放射科医生必须熟悉急性肺栓塞的病理生理学以及其他团队成员提供的护理原则。关键点：问题 高危肺栓塞的推荐治疗方法是全身溶栓。用于经皮抽吸血栓切除术的新设备旨在改变治疗模式，需要严格审查。研究结果 观察数据表明新型血栓切除术设备具有安全性和有效性，随机对照试验正在进行。导管定向溶栓的附加价值尚不清楚。临床意义 全身溶栓可降低高危肺栓塞患者的死亡率，但在经验丰富的中心之外使用频率极低。经皮大口径肺血栓切除术在填补中高危肺栓塞的治疗空白和改变指南方面具有巨大潜力。
