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CDI 'viable treatment option' for massive PE
15 August 2008
MedWire News: Catheter-directed intervention (CDI) should be included in the armamentarium for massive pulmonary embolism (PE), results from a case series suggest.
The research, published in the journal Chest, describes the outcome of 12 patients who were treated by suction embolectomy and fragmentation, with or without local thrombolysis.
"In the setting of hemodynamic shock from massive PE, CDI is potentially a life-saving treatment for patients who have not responded to or cannot tolerate systemic thrombolysis," say William Kuo and co-authors, from Stanford University Medical Center in California, USA.
The team reviewed medical records for 12 patients who underwent CDI between 1997 and 2006 for angiographically confirmed massive PE with hemodynamic shock. Eight patients also received catheter-guided thrombolysis and 10 received an inferior vena cava filter.
Seven patients were treated with CDI secondary to failed systemic tissue plasminogen activator treatment, while five patients underwent primary CDI due to thrombolysis contraindications.
Overall, 100% of the procedures were technically successful and none of the patients experienced major complications.
Ten (83%) patients experienced significant hemodynamic improvement, defined as a shock index of less than 9, and were stable until they left hospital, after an average of 20 days. The remaining two patients died within 24 hours of CDI.
"Although CDI involves catheterization of the pulmonary arteries, it is much less invasive than open surgical embolectomy," Kuo et al note.
"When patients are poor candidates for systemic thrombolysis and surgical embolectomy, CDI may be the only viable treatment option and should be pursued if available."
Acknowledging the lack of a widely accepted protocol for CDI, the team concludes: "Prospective large-scale studies are needed to further validate the safety and effectiveness of CDI and to determine its ideal role in the management algorithm for PE."
