EkoSonic Endovascular System for patients with acute pulmonary embolism and contraindication to systemic fibrinolysis. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Visco, Emanuele; Adamo, Marianna; Locantore, Elisa; Fiorina, Claudia; Chizzola, Giuliano; Branca, Luca; Abbenante, Alessandro; Castiello, Assunta; Metra, Marco; Curello, Salvatore; Ettori, Federica
• Is Part Of: Journal of cardiovascular medicine. Volume 20:Issue 3(2019:Mar.)
• Publication Date: 2019-03
• Subjects: acute pulmonary embolism -- catheter-directed thrombolysis -- EkoSonic Endovascular System; Cardiology -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiology -- Periodicals; Cardiovascular Diseases -- Periodicals; 616.1005
• DOI: 10.2459/JCM.0000000000000751
• Languages: English
• ISSNs: 1558-2027

Abstract

Abstract : Aims: The aim of this study was to evaluate the safety and efficacy of the EkoSonic Endovascular System (EKOS) in patients with acute pulmonary embolism (APE) at high or intermediate-high risk and contraindication to systemic fibrinolysis. Methods: This is a retrospective study including consecutive patients admitted due to high-risk or intermediate-high-risk APE and treated by EKOS because of an absolute or relative contraindication to systemic fibrinolysis. The primary efficacy end-point was the change from baseline to 72 h in right to left ventricular dimension ratio [right ventricular/left ventricular (RV/LV) ratio]; pulmonary embolic burden using the Qanadli Index; and systolic pulmonary arterial pressure (SPAP). The primary safety end-point was the occurrence of bleeding (GUSTO classification) within 72 h. Results: Eighteen patients (5 men, 13 women; mean age 74 ± 12.7 years) affected by high-risk APE ( n = 5; 27.8%) or intermediate-high-risk APE ( n = 13; 72.2%) were included. A significant reduction of mean RV/LV ratio (1.38 ± 0.3 vs. 0.97 ± 0.16; P < 0.0005); Qanadli Index [27.06 ± 2.6 vs. 18.8 ± 7.8 ( P < 0.001) and SPAP (71.1 ± 12 vs. 45.2 ± 16 mmHg; P < 0.001)] was observed within 72 h after EKOS. Five bleeding events occurred: one fatal and four moderates; three out of them led to the access site hematoma, two due to pre-existing active bleeding. Conclusion: EKOS is an effective tool to treat patients with APE at high or intermediate-high risk and contraindication to fibrinolysis. It is a relatively safe therapy considering the critical conditions and high bleeding risk of the receiving population.