Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism
PURPOSECatheter-directed thrombolysis (CDT) is an emerging, minimally invasive treatment for patients with massive and submassive pulmonary embolism (PE). The value of follow-up pulmonary angiography for evaluating improvement after CDT is limited by a paucity of large studies assessing its utility...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Galenos Publishing House
2019-07-01
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| Series: | Diagnostic and Interventional Radiology |
| Online Access: |
http://www.dirjournal.org/archives/archive-detail/article-preview/value-of-follow-up-angiography-additional-interven/54904
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| _version_ | 1797691309058686976 |
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| author | Osman Ahmed Nhi Vo Mikin V. Patel Nerina DiSomma Merve Özen Bülent Arslan |
| author_facet | Osman Ahmed Nhi Vo Mikin V. Patel Nerina DiSomma Merve Özen Bülent Arslan |
| author_sort | Osman Ahmed |
| collection | DOAJ |
| description | PURPOSECatheter-directed thrombolysis (CDT) is an emerging, minimally invasive treatment for patients with massive and submassive pulmonary embolism (PE). The value of follow-up pulmonary angiography for evaluating improvement after CDT is limited by a paucity of large studies assessing its utility and role for additional intervention. The purpose of our study was to assess the role of next-day pulmonary angiography for CDT in patients with acute massive and submassive PE undergoing continuous pulmonary arterial pressure monitoring, and secondarily, determine factors that are correlated with a need for further therapy.METHODSPatients who underwent CDT from 2006 to 2016 for massive and submassive PE were reviewed. Patient demographics, comorbidities, preprocedural lab results, noninvasive hemodynamic studies, and technical variables were recorded. Among patients receiving next-day angiography, those requiring further therapy, defined as continued CDT beyond the standard 24 hours (with or without catheter repositioning or exchange) and/or mechanical or suction thrombectomy were contrasted with those not requiring additional therapy to assess for the role of angiography and patient factors that correlate with need for further therapy.RESULTSThirty-two patients underwent CDT for massive (n=14) and submassive (n=18) PE. Eighteen (56.3%) were male, 14 (43.7%) were Caucasian, 18 (56.3%) were African-American, with a mean age of 66.2 years (range, 26–87 years). Of the 27 (84.4%) patients that underwent next-day pulmonary angiography, 16 (59.3%) did not require additional therapy and 11 (40.7%) did require additional therapy. Additional therapy included extended CDT beyond 24 hours (n=4), mechanical/suction thrombectomy (n=5), or both extended CDT and mechanical/suction thrombectomy (n=2). Younger age (50.1 vs. 62.2 years, P = 0.039) was correlated with a need for further therapy. Initial (40.7 vs. 34.8 mmHg, P = 0.248), next-day (31.5 vs. 26.3 mmHg, P = 0.259), and interval change (4.6 vs. 8.0 mmHg, P = 0.669) in pulmonary artery pressures were not statistically significant between patient subsets. Preprocedural right ventricular/left ventricular ratio (RV/LV) also did not differ significantly (1.74 vs. 1.75, P = 0.961). Thirty-day mortality was comparable (2 vs. 1, P = 0.332).CONCLUSIONNext-day pulmonary angiography is a useful method to identify patients needing additional therapy including extended CDT and/or mechanical or suction thrombectomy in acute PE management. Pulmonary arterial pressures and preprocedural RV/LV ratios were not found to be predicative of those requiring further intervention. |
| first_indexed | 2024-03-12T02:11:35Z |
| format | Article |
| id | doaj.art-d4096fc50b2048bda4818047f3c134e1 |
| institution | Directory Open Access Journal |
| issn | 1305-3825 1305-3612 |
| language | English |
| last_indexed | 2024-03-12T02:11:35Z |
| publishDate | 2019-07-01 |
| publisher | Galenos Publishing House |
| record_format | Article |
| series | Diagnostic and Interventional Radiology |
| spelling | doaj.art-d4096fc50b2048bda4818047f3c134e12023-09-06T13:01:57ZengGalenos Publishing HouseDiagnostic and Interventional Radiology1305-38251305-36122019-07-0125429830310.5152/dir.2019.1814213049054Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolismOsman Ahmed0Nhi Vo1Mikin V. Patel2Nerina DiSomma3Merve Özen4Bülent Arslan5 Department of Radiology, Rush University School of Medicine, Chicago, IL, USA Department of Radiology, Rush University School of Medicine, Chicago, IL, USA Department of Radiology, Northwestern Medicine, Chicago, IL, USA Department of Radiology, Rush University School of Medicine, Chicago, IL, USA Department of Radiology, Rush University School of Medicine, Chicago, IL, USA Department of Radiology, Rush University School of Medicine, Chicago, IL, USA PURPOSECatheter-directed thrombolysis (CDT) is an emerging, minimally invasive treatment for patients with massive and submassive pulmonary embolism (PE). The value of follow-up pulmonary angiography for evaluating improvement after CDT is limited by a paucity of large studies assessing its utility and role for additional intervention. The purpose of our study was to assess the role of next-day pulmonary angiography for CDT in patients with acute massive and submassive PE undergoing continuous pulmonary arterial pressure monitoring, and secondarily, determine factors that are correlated with a need for further therapy.METHODSPatients who underwent CDT from 2006 to 2016 for massive and submassive PE were reviewed. Patient demographics, comorbidities, preprocedural lab results, noninvasive hemodynamic studies, and technical variables were recorded. Among patients receiving next-day angiography, those requiring further therapy, defined as continued CDT beyond the standard 24 hours (with or without catheter repositioning or exchange) and/or mechanical or suction thrombectomy were contrasted with those not requiring additional therapy to assess for the role of angiography and patient factors that correlate with need for further therapy.RESULTSThirty-two patients underwent CDT for massive (n=14) and submassive (n=18) PE. Eighteen (56.3%) were male, 14 (43.7%) were Caucasian, 18 (56.3%) were African-American, with a mean age of 66.2 years (range, 26–87 years). Of the 27 (84.4%) patients that underwent next-day pulmonary angiography, 16 (59.3%) did not require additional therapy and 11 (40.7%) did require additional therapy. Additional therapy included extended CDT beyond 24 hours (n=4), mechanical/suction thrombectomy (n=5), or both extended CDT and mechanical/suction thrombectomy (n=2). Younger age (50.1 vs. 62.2 years, P = 0.039) was correlated with a need for further therapy. Initial (40.7 vs. 34.8 mmHg, P = 0.248), next-day (31.5 vs. 26.3 mmHg, P = 0.259), and interval change (4.6 vs. 8.0 mmHg, P = 0.669) in pulmonary artery pressures were not statistically significant between patient subsets. Preprocedural right ventricular/left ventricular ratio (RV/LV) also did not differ significantly (1.74 vs. 1.75, P = 0.961). Thirty-day mortality was comparable (2 vs. 1, P = 0.332).CONCLUSIONNext-day pulmonary angiography is a useful method to identify patients needing additional therapy including extended CDT and/or mechanical or suction thrombectomy in acute PE management. Pulmonary arterial pressures and preprocedural RV/LV ratios were not found to be predicative of those requiring further intervention. http://www.dirjournal.org/archives/archive-detail/article-preview/value-of-follow-up-angiography-additional-interven/54904 |
| spellingShingle | Osman Ahmed Nhi Vo Mikin V. Patel Nerina DiSomma Merve Özen Bülent Arslan Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism Diagnostic and Interventional Radiology |
| title | Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism |
| title_full | Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism |
| title_fullStr | Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism |
| title_full_unstemmed | Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism |
| title_short | Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism |
| title_sort | value of follow up angiography additional interventions in patients undergoing catheter directed thrombolysis for massive and submassive pulmonary embolism |
| url |
http://www.dirjournal.org/archives/archive-detail/article-preview/value-of-follow-up-angiography-additional-interven/54904
|
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