仅使用功率脉冲喷射辅助血块破碎的单次导管定向溶栓术是治疗急性肺栓塞的快速、安全和有效的选择

IF 2.8 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Laurencia Villalba MD, FRACS, FACP , Raeed Deen MD, MMedStats , Brendan Tonson-Older MChD, PhD , Cartan Costello MB, BCD, BAO, FCICM
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引用次数: 0

摘要

目的评估单次导管引导溶栓疗法(CDT)的安全性和有效性,该疗法仅辅助动力脉冲喷射(PPS),不进行血栓切除术。我们对前瞻性收集的数据进行了单中心回顾性分析。方法研究纳入了符合纳入标准并接受了单次 CDT-PPS 治疗的高危或中危肺栓塞(PE)患者。评估的主要结果是技术和临床成功率以及主要不良事件。次要结果包括干预前后临床检查的有效性、放射学检查结果以及出院 48 小时和 4 周后超声心动图和计算机断层扫描肺血管造影显示的右心室功能障碍逆转情况。此外,还对重症监护室的住院时间和整个入院时间进行了分析。结果在2016年5月至2023年1月期间,卧龙岗医院有104名患者被诊断为高危或中危PE,并接受了CDT-PPS治疗。在 104 名患者中,49 人(47%)被认为患有高危 PE,55 人(53%)被认为患有中危 PE。11名患者(11%)有全身溶栓的绝对禁忌症,49名患者(47%)有相对禁忌症。102名患者(98%)获得了技术成功。48小时存活率为99%,4周存活率为96%,12个月存活率为91%。4周时,超声心动图显示98%的患者没有右心功能不全的迹象,计算机断层扫描肺血管造影显示72%的患者PE完全消退。48 小时内未发生重大不良事件。重症监护室的中位住院时间为1天,总住院时间为6天。结论 CDT-PPS 技术在治疗高危和中危 PE 方面快速、安全、有效,即使是出血风险较高的患者也不例外,在技术和资源允许的情况下,应将其视为一线治疗方法。需要进一步的多中心前瞻性研究来证实这些结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Single-session catheter-directed lysis using adjunctive clot fragmentation with power pulse spray only is a fast, safe, and effective option for acute pulmonary embolism

Objective

Single-session, catheter-directed thrombolysis (CDT) with adjunctive power pulse spray (PPS) only, without thrombectomy, was evaluated for its safety and effectiveness. We performed a single-center, retrospective analysis of prospectively collected data.

Methods

Patients with high-risk or intermediate-risk pulmonary embolism (PE) who met the inclusion criteria and underwent a single session of CDT-PPS were included in the study. The primary outcomes assessed were technical and clinical success and major adverse events. Secondary outcomes included effectiveness based on pre- and postintervention clinical examination, radiographic findings, and reversal of right ventricular dysfunction at 48 hours and 4 weeks after discharge on echocardiography and computed tomography pulmonary angiography. The length of stay in the intensive care unit and overall admission were also analyzed. A return to premorbid exercise tolerance was evaluated at 12 months after the procedure.

Results

Between May 2016 and January 2023, 104 patients at the Wollongong Hospital were diagnosed with high- or intermediate-risk PE and underwent CDT-PPS. Of the 104 patients, 49 (47%) were considered to have high-risk PE and 55 (53%) intermediate-risk PE. Eleven patients (11%) had absolute contraindications and 49 patients (47%) had relative contraindications to systemic thrombolysis. Technical success was achieved in 102 patients (98%). Survival was 99% at 48 hours, 96% at 4 weeks, and 91% at 12 months. At 4 weeks, echocardiography showed 98% of patients had no evidence of right heart dysfunction, and computed tomography pulmonary angiography showed complete resolution of PE in 72%. There were no major adverse events at 48 hours. The median intensive care unit length of stay was 1 day, and the overall length of stay was 6 days. At 12 months, 96% had returned to their premorbid status.

Conclusions

The CDT-PPS technique is fast, safe, and effective in the treatment of high- and intermediate-risk PE, even in patients with a high bleeding risk, and should be considered as first-line management when the skills and resources are available. Further multicenter prospective studies are needed to corroborate these results.

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来源期刊
Journal of vascular surgery. Venous and lymphatic disorders
Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE
CiteScore
6.30
自引率
18.80%
发文量
328
审稿时长
71 days
期刊介绍: Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.
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