Was ist neu?
Evidenz der systemischen Lysetherapie als Standardverfahren zur Rekanalisation Die Evidenz der systemischen Lysetherapie in High- und Intermediate-High-Lungenembolien
ist niedrig. Ohne rekanalisierende Maßnahmen führt die Rechtsherz-Dekompensation in
High- und Intermediate-High-Risk-Lungenembolien oft zum Tod.
Kathetergestützte Techniken In den letzten Jahren wurden mehrere Systeme zur interventionellen Rekanalisation
bei Lungenembolie etabliert. Wie in anderen Feldern der vaskulären Medizin sind interventionelle
Rekanalisationsmethoden auch bei der Lungenembolie potenziell effektiver als die systemische
Lysetherapie, unter Umgehung erhöhter Blutungsrisiken. Auch wenn bisher Ergebnisse
laufender randomisierter kontrollierter Endpunktstudien noch ausstehen, sind die bisherigen
Daten vielversprechend.
Die Rolle des PERT-Teams Die zunehmend komplexere Behandlung der Lungenembolie erfordert spezialisierte interdisziplinäre
Behandlungsteams, sog. Pulmonary-Artery-Response-Teams (PERT-Teams) und strukturierte
Behandlungsabläufe.
Abstract
Several catheter-based systems have been developed for interventional recanalization
of pulmonary embolism. These include local ultrasound assisted thrombolysis (EKOS),
in-toto-thrombectomy via retriever and aspiration system (FlowTriever) and the Indigo
mechanical aspiration system. Safety and efficacy in the removal of thrombus have
been demonstrated for all systems. Interventional recanalization strategies for high-
and intermediate-high risk pulmonary embolism are potentially more effective in the
removal of thrombus and restoration of right heart function than systemic thrombolysis
with a lower risk of major bleeding complications. Preliminary data from registries
and observational studies are very promising whereas the evidence for systemic thrombolysis
treatment in high and intermediate-high risk pulmonary embolism is low. Randomized
controlled clinical trials are currently performed comparing catheter based interventional
therapies to systemic thrombolysis for the treatment of intermediate-high risk pulmonary
embolisms. Primary outcome measurements include mortality, hemodynamic collapse, and
major bleedings. Results are expected in 2025. The introduction of interventional
therapies for pulmonary embolism was accompanied by an increased awareness of the
complexity of pulmonary embolism management. The need for specialized interdisciplinary
pulmonary embolism response teams (PERT-teams) and a well-structured approach including
a PDCA cycle was recognized.
Schlüsselwörter
Lungenarterienembolie - Rekanalisation - interventionell - Thrombolyse - PERT-Team
- Qualitätsmanagement
Keywords
pulmonary embolism - recanalization - interventional - thrombolysis - PERT-Team -
quality management
