Cath Lab Digest

Tell us about the study you conducted involving a new treatment for acute massive pulmonary embolism. How large was this study? How long were the patients studied? What were its findings?

The study involves using an ultrasound-accelerated catheter technology to complement thrombolytic therapy in patients with massive pulmonary embolism (PE) who have hemodynamic instability. There were a total of 32 patients with massive PE who have been treated with this treatment strategy. We found that ultrasound-accelerated thrombolysis can reduce the thrombolytic treatment duration and thrombolytic dosage compared to patients treated with traditional catheter-directed thrombolysis.

The new treatment you studied, called ultrasound-accelerated catheter-directed thrombolysis (EkoSonic® Endovascular System, EKOS Corp., Bothell, Washington), is an extension of catheter-directed thrombolysis (CDT). Describe how this new technology works compared to CDT.

The addition of the ultrasound energy, emitted via the thrombolytic catheter, can accelerate the breakdown of fibrin bond, which increases the surface area exposure to the thrombolytic agent. This accelerates the thrombolytic process and enables a greater degree of thrombolysis over shorter treatment duration.

In what types of clinical scenarios is ultrasound-accelerated CDT to be used?

Ultrasound-accelerated CDT is commonly used in patients with symptomatic lower leg deep vein thrombosis or iliofemoral deep vein thrombosis.

How quickly is improvement seen in patients treated with ultrasound-assisted CDT compared to the standard therapy?

In our study, the ultrasound treatment group had reduced thrombolytic dosage compared to the traditional CDT group. The treatment duration for ultrasound-accelerated CDT was shorter than the traditional CDT group.

Were there any complications with this procedure?

There were no differences in complication rates between those treated with ultrasound-accelerated CDT versus standard CDT. However, patients who received ultrasound-accelerated CDT had no blood transfusion requirement compared to those treated with standard CDT.

What is the learning curve for this ultrasound-accelerated CTD?

There is no additional learning curve for ultrasound-accelerated CDT. This treatment technique requires the same interventional skills and catheter-based techniques.

Will this new technique have applications outside of acute massive PE?

This technology can be use in patients with acute deep vein thrombosis or acute arterial thrombosis.

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Dr. Peter H. Lin is Professor of Surgery and Chief of the Division of Vascular Surgery & Endovascular Therapy of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine. He also serves as the program director of the Vascular Surgery fellowship program at the Baylor College of Medicine in Houston, Texas. Dr. Lin is a nationally recognized physician in the treatment of vascular disease. He specializes in all aspects of vascular treatment of arterial and venous conditions.

About VEITHsymposium: Now in its fourth decade, VEITHsymposium provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features over 400 rapid-fire presentations from world-renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques. For more information about VEITHsymposium, visit: www.veithsymposium.org