Researchers compared ultrasound-accelerated endovascular thrombolysis (USAT) and pigtail catheter-directed thrombolysis (PCDT) for the treatment of acute pulmonary embolism (PE), and they found that the techniques are similarly effective and safe.
The literature already supports the efficacy of USAT for treating acute PE, but such treatment can be complex and time consuming. Treatment with PCDT may help to avoid a long procedure; however, data on the efficacy of PCDT are lacking, as are studies comparing the two methods of treatment.
To address this gap in the literature, the researchers conducted a single-center, retrospective study of patients treated with USAT or PCDT for acute massive or submassive PE. They reviewed 60 treatments that occurred between January 2010 and December 2016, including 52 cases of submassive PE and 8 cases of massive PE.
Results showed that both USAT and PCDT led to a significant decrease in pulmonary artery pressure, with reductions of 7.4 mm Hg for USAT and 8.2 mm Hg for PCDT. Miller index scores also decreased in both groups (reductions of 45.8% for USAT and 53% for PCT).
Procedures times differed between the groups though. It took significantly longer to perform USAT procedures than PCDT procedures. “As expected, placement of a pigtail catheter is significantly more expeditious than placement of a USAT catheter. Shorter procedure times may be critical in the acutely ill PE population,” the study’s authors wrote.
There were some additional differences that were not statistically significant between the groups—the group receiving USAT underwent fewer sessions with shorter infusion times and a lower total dose of tissue plasminogen activator.
The groups had similar safety profiles, and there were no significant differences in complications or 30-day mortality rates between the groups.
“In conclusion, USAT and PCDT demonstrated significant and comparable effectiveness in reducing PAP and thrombus burden when compared through a similar duration of treatment, without a significant difference in the total dose of TPA infused,” the researchers stated.
Graif A, Grilli CJ, Kimbiris G, et al. Comparison of ultrasound-accelerated versus pigtail catheter-directed thrombolysis for the treatment of acute massive and submassive pulmonary embolism. J Vasc Interv Radiol. 2017;28(10):1339-1347.