[Italian Society of Interventional Cardiology (SICI-GISE) Position paper: Integrated management and transcatheter interventions for acute pulmonary embolism].
Chiara Fraccaro, Mario Iannaccone, Giacomo Giovanni Boccuzzi, Annalisa Boscolo Bozza, Gianpaolo Carrafiello, Andrea Dell'Amore, Luigi Di Serafino, Sofia Martin Suarez, Antonio Micari, Andrea Rolandi, Filippo Russo, Stefano Carugo, Antonio Di Lascio, Francesco Germinal, Simona Pierini, Alberto Menozzi, Massimo Fineschi, Tiziana Attisano, Marco Contarini, Carmine Musto, Federico De Marco, Alfredo Marchese, Giovanni Esposito, Giuseppe Tarantini, Francesco Saia
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引用次数: 0
Abstract
Pulmonary embolism (PE) is commonly treated primarily with pharmacological therapy, while advanced reperfusion therapies (transcatheter or surgical) are considered only in cases of contraindications or failure of standard therapies. Treatment algorithms vary depending on the patient's risk, with patients at intermediate or high risk potentially requiring evaluation for such advanced reperfusion therapies. Critical scenarios, such as contraindications to systemic thrombolysis or failure of pharmacological protocols, necessitate the activation of a multidisciplinary pulmonary embolism response team (PERT) and prompt therapeutic escalation. Integrated in-hospital pathways and the extension of PERT at the provincial/regional level are recommended to improve access to advanced therapies and promote uniform management of PE. Larger randomized clinical trials are needed to assess the efficacy of transcatheter therapies compared to current standards. In conclusion, a multidisciplinary and standardized approach, supported by evidence-based guidelines, is essential to optimize PE management and improve clinical outcomes. The Italian Society of Interventional Cardiology (SICI-GISE) aims to promote such standardization nationally with this expert position paper, ensuring appropriateness and equity of care for patients, as well as fostering further scientific research and education.
肺栓塞(PE)通常主要采用药物治疗,而高级再灌注疗法(经导管或手术)只有在禁忌症或标准疗法失败的情况下才会考虑。治疗算法因患者的风险而异,中度或高度风险患者可能需要评估此类高级再灌注疗法。在出现全身溶栓禁忌症或药物治疗方案失败等危急情况时,有必要启动多学科肺栓塞应对小组(PERT),并迅速升级治疗方案。建议采用综合院内路径,并将 PERT 扩展到省级/地区级,以改善先进疗法的可及性,促进 PE 的统一管理。需要进行更大规模的随机临床试验,以评估经导管疗法与现行标准相比的疗效。总之,在循证指南的支持下,多学科和标准化的方法对于优化 PE 管理和改善临床预后至关重要。意大利介入心脏病学会(SICI-GISE)旨在通过这份专家立场文件在全国推广这种标准化方法,确保为患者提供适当、公平的治疗,并促进进一步的科学研究和教育。