Download PDF
Int J Angiol 2022; 31(03): 179-187
DOI: 10.1055/s-0042-1755573
Invited Article

Massive Embolism: Knife versus PCI

Scarlett Tohme
1   Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, New York
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Joshua S. Newman 
1   Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, New York
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Christopher Gasparis
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Frank Manetta 
1   Department of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, Manhasset, New York
2   Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Pulmonary embolism is the third most common cardiovascular syndrome with an estimated up to 25% of patients presenting with sudden death. For those who survive, a mainstay of management for patients with hemodynamic stability is anticoagulation; however, recommendations and options are rapidly changing for patients with submassive or massive pulmonary embolism with hemodynamic instability. Catheter-based and surgical approaches offer efficacious management options for unstable patients or patients with contraindications to anticoagulation; however, both approaches have inherent benefits and risk. This article seeks to offer a brief review on the recommendations and options for management of pulmonary embolism from both surgical and catheter-based perspectives.

Keywords

pulmonary embolism - catheter-directed thrombolysis - catheter-based embolectomy - surgical pulmonary embolectomy - extracorporeal membrane oxygenation - ECMO


Publication History

Article published online:
20 August 2022

© 2022. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Konstantinides SV, Meyer G, Becattini C. et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
    Google Scholar
  • 2 Raskob GE, Angchaisuksiri P, Blanco AN. et al; ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014; 34 (11) 2363-2371
    CrossrefPubMedGoogle Scholar
  • 3 Heit JA. The epidemiology of venous thromboembolism in the community. Arterioscler Thromb Vasc Biol 2008; 28 (03) 370-372
    CrossrefPubMedGoogle Scholar
  • 4 Silverstein MD, Heit JA, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 1998; 158 (06) 585-593
    CrossrefPubMedGoogle Scholar
  • 5 Erythropoulou-Kaltsidou A, Alkagiet S, Tziomalos K. New guidelines for the diagnosis and management of pulmonary embolism: key changes. World J Cardiol 2020; 12 (05) 161-166
    CrossrefPubMedGoogle Scholar
  • 6 White RH. The epidemiology of venous thromboembolism. Circulation 2003; 107 (23, Suppl 01) I4-I8
    CrossrefPubMedGoogle Scholar
  • 7 Beall Jr AC, Cooley DA, Debakey ME. Surgical management of pulmonary embolism: experimental and clinical considerations. Dis Chest 1965; 47: 382-391
    CrossrefPubMedGoogle Scholar
  • 8 McFadden PM, Ochsner JL. Aggressive approach to pulmonary embolectomy for massive acute pulmonary embolism: a historical and contemporary perspective. Mayo Clin Proc 2010; 85 (09) 782-784
    CrossrefPubMedGoogle Scholar
  • 9 Giri J, Sista AK, Weinberg I. et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the American Heart Association. Circulation 2019; 140 (20) e774-e801
    Google Scholar
  • 10 Aujesky D, Obrosky DS, Stone RA. et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005; 172 (08) 1041-1046
    CrossrefPubMedGoogle Scholar
  • 11 Jiménez D, Aujesky D, Moores L. et al; RIETE Investigators. Simplification of the Pulmonary Embolism Severity Index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010; 170 (15) 1383-1389
    CrossrefPubMedGoogle Scholar
  • 12 Steffel J, Verhamme P, Potpara TS. et al; ESC Scientific Document Group. The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: executive summary. Europace 2018; 20 (08) 1231-1242
    Google Scholar
  • 13 Becattini C, Agnelli G, Salvi A. et al; TIPES Study Group. Bolus tenecteplase for right ventricle dysfunction in hemodynamically stable patients with pulmonary embolism. Thromb Res 2010; 125 (03) e82-e86
    CrossrefPubMedGoogle Scholar
  • 14 Goldhaber SZ, Haire WD, Feldstein ML. et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993; 341 (8844): 507-511
    CrossrefPubMedGoogle Scholar
  • 15 Mullan CW, Newman J, Geib M. et al. Modern treatment trends and outcomes of pulmonary embolism with and without hemodynamic significance. Ann Thorac Surg 2020; 110 (05) 1534-1540
    CrossrefPubMedGoogle Scholar
  • 16 Avgerinos ED, Saadeddin Z, Abou Ali AN. et al. A meta-analysis of outcomes of catheter-directed thrombolysis for high- and intermediate-risk pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2018; 6 (04) 530-540
    CrossrefPubMedGoogle Scholar
  • 17 Rothschild DP, Goldstein JA, Ciacci J, Bowers TR. Ultrasound-accelerated thrombolysis (USAT) versus standard catheter-directed thrombolysis (CDT) for treatment of pulmonary embolism: a retrospective analysis. Vasc Med 2019; 24 (03) 234-240
    CrossrefPubMedGoogle Scholar
  • 18 Devcic Z, Kuo WT. Percutaneous pulmonary embolism thrombectomy and thrombolysis: technical tips and tricks. Semin Intervent Radiol 2018; 35 (02) 129-135
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Timsit JF, Reynaud P, Meyer G, Sors H. Pulmonary embolectomy by catheter device in massive pulmonary embolism. Chest 1991; 100 (03) 655-658
    CrossrefPubMedGoogle Scholar
  • 20 Pelliccia F, Schiariti M, Terzano C. et al. Treatment of acute pulmonary embolism: update on newer pharmacologic and interventional strategies. BioMed Res Int 2014; 2014: 410341
    CrossrefPubMedGoogle Scholar
  • 21 Li K, Cui M, Zhang K, Liang K, Liu H, Zhai S. Treatment of acute pulmonary embolism using rheolytic thrombectomy. EuroIntervention 2021; 17 (02) e158-e166
    CrossrefPubMedGoogle Scholar
  • 22 Margheri M, Vittori G, Vecchio S. et al. Early and long-term clinical results of AngioJet rheolytic thrombectomy in patients with acute pulmonary embolism. Am J Cardiol 2008; 101 (02) 252-258
    CrossrefPubMedGoogle Scholar
  • 23 Deák Z, Strube H, Sadeghi-Azandaryani M, Reiser MF, Treitl M. Rotational thrombectomy of acute peripheral vascular occlusions using the ThromCat XT device: techniques, indications and initial results. Diagn Interv Radiol 2011; 17 (03) 283-289
    PubMedGoogle Scholar
  • 24 Dumantepe M, Teymen B, Akturk U, Seren M. Efficacy of rotational thrombectomy on the mortality of patients with massive and submassive pulmonary embolism. J Card Surg 2015; 30 (04) 324-332
    CrossrefPubMedGoogle Scholar
  • 25 Liu S, Shi HB, Gu JP. et al. Massive pulmonary embolism: treatment with the Rotarex thrombectomy system. Cardiovasc Intervent Radiol 2011; 34 (01) 106-113
    CrossrefPubMedGoogle Scholar
  • 26 de Winter MA, Vlachojannis GJ, Ruigrok D, Nijkeuter M, Kraaijeveld AO. Rationale for catheter-based therapies in acute pulmonary embolism. Eur Heart J Suppl 2019; 21 (Suppl I): I16-I22
    CrossrefPubMedGoogle Scholar
  • 27 Avgerinos ED, Abou Ali A, Toma C. et al. Catheter-directed thrombolysis versus suction thrombectomy in the management of acute pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2019; 7 (05) 623-628
    CrossrefPubMedGoogle Scholar
  • 28 Geller BJ, Adusumalli S, Pugliese SC. et al. Outcomes of catheter-directed versus systemic thrombolysis for the treatment of pulmonary embolism: a real-world analysis of national administrative claims. Vasc Med 2020; 25 (04) 334-340
    CrossrefPubMedGoogle Scholar
  • 29 Cires-Drouet RS, Nagarsheth K, Kaczorowski DJ. et al. Catheter-based interventions versus medical and surgical approaches in acute pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2021; 9 (06) 1382-1390
    CrossrefPubMedGoogle Scholar
  • 30 Loyalka P, Ansari MZ, Cheema FH, Miller III CC, Rajagopal S, Rajagopal K. Surgical pulmonary embolectomy and catheter-based therapies for acute pulmonary embolism: a contemporary systematic review. J Thorac Cardiovasc Surg 2018; 156 (06) 2155-2167
    CrossrefPubMedGoogle Scholar
  • 31 Winters AA, McDaniel MJ, Binongo JN. et al. A comparison of surgical pulmonary embolectomy and catheter-directed lysis for life-threatening pulmonary emboli. Interact Cardiovasc Thorac Surg 2020; 30 (03) 388-393
    CrossrefPubMedGoogle Scholar
  • 32 Pasrija C, Kronfli A, Rouse M. et al. Outcomes after surgical pulmonary embolectomy for acute submassive and massive pulmonary embolism: a single-center experience. J Thorac Cardiovasc Surg 2018; 155 (03) 1095-1106 .e2
    CrossrefPubMedGoogle Scholar
  • 33 Bova C, Pesavento R, Marchiori A. et al; TELESIO Study Group. Risk stratification and outcomes in hemodynamically stable patients with acute pulmonary embolism: a prospective, multicentre, cohort study with three months of follow-up. J Thromb Haemost 2009; 7 (06) 938-944
    CrossrefPubMedGoogle Scholar
  • 34 Kostrubiec M, Pruszczyk P, Bochowicz A. et al. Biomarker-based risk assessment model in acute pulmonary embolism. Eur Heart J 2005; 26 (20) 2166-2172
    CrossrefPubMedGoogle Scholar
  • 35 Hartman AR, Manetta F, Lessen R. et al. Acute surgical pulmonary embolectomy: a 9-year retrospective analysis. Tex Heart Inst J 2015; 42 (01) 25-29
    CrossrefPubMedGoogle Scholar
  • 36 Choi JH, O'Malley TJ, Maynes EJ. et al. Surgical pulmonary embolectomy outcomes for acute pulmonary embolism. Ann Thorac Surg 2020; 110 (03) 1072-1080
    CrossrefPubMedGoogle Scholar
  • 37 Kilic A, Emani S, Sai-Sudhakar CB, Higgins RS, Whitson BA. Donor selection in heart transplantation. J Thorac Dis 2014; 6 (08) 1097-1104
    PubMedGoogle Scholar
  • 38 Meneveau N, Séronde MF, Blonde MC. et al. Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest 2006; 129 (04) 1043-1050
    Google Scholar
  • 39 Kon ZN, Pasrija C, Bittle GJ. et al. The incidence and outcomes of surgical pulmonary embolectomy in North America. Ann Thorac Surg 2019; 107 (05) 1401-1408
    CrossrefPubMedGoogle Scholar
  • 40 Neely RC, Byrne JG, Gosev I. et al. Surgical embolectomy for acute massive and submassive pulmonary embolism in a series of 115 patients. Ann Thorac Surg 2015; 100 (04) 1245-1251 , discussion 1251–1252
    CrossrefPubMedGoogle Scholar
  • 41 Keeling WB, Sundt T, Leacche M. et al; SPEAR Working Group. Outcomes after surgical pulmonary embolectomy for acute pulmonary embolus: a multi-institutional study. Ann Thorac Surg 2016; 102 (05) 1498-1502
    CrossrefPubMedGoogle Scholar
  • 42 Extracorporeal Life Support Organization. ELSO Guidelines for Cardiopulmonary Extracorpreal Life Support. Ann Arbor, MI: Extracorporeal Life Support Organization; 2017
    Google Scholar
  • 43 Sertic F, Diagne D, Chavez L. et al. Mid-term outcomes with the use of extracorporeal membrane oxygenation for cardiopulmonary failure secondary to massive pulmonary embolism. Eur J Cardiothorac Surg 2020; 58 (05) 923-931
    CrossrefPubMedGoogle Scholar
  • 44 George B, Parazino M, Omar HR. et al. A retrospective comparison of survivors and non-survivors of massive pulmonary embolism receiving veno-arterial extracorporeal membrane oxygenation support. Resuscitation 2018; 122: 1-5
    CrossrefPubMedGoogle Scholar
  • 45 Newman JS, Park D, Manetta F. Extracorporeal membrane oxygenation for failed TPA therapy of pulmonary embolism. Adv Cardiovasc Res 2018; 1 (04) ACR.MS.ID.000116. DOI: 10.32474/ACR.
    CrossrefPubMedGoogle Scholar
  • 46 Malekan R, Saunders PC, Yu CJ. et al. Peripheral extracorporeal membrane oxygenation: comprehensive therapy for high-risk massive pulmonary embolism. Ann Thorac Surg 2012; 94 (01) 104-108
    CrossrefPubMedGoogle Scholar
  • 47 Dudzinski DM, Piazza G. Multidisciplinary Pulmonary Embolism Response Teams. Circulation 2016; 133 (01) 98-103
    CrossrefPubMedGoogle Scholar
  • 48 Barnes GD, Kabrhel C, Courtney DM. et al; National PERT Consortium Research Committee. Diversity in the Pulmonary Embolism Response Team model: an organizational survey of the National PERT Consortium Members. Chest 2016; 150 (06) 1414-1417
    CrossrefPubMedGoogle Scholar
  • 49 Solomon RS, Corwin GS, Barclay DC, Quddusi SF, Dannenberg MD. Effectiveness of rapid response teams on rates of in-hospital cardiopulmonary arrest and mortality: a systematic review and meta-analysis. J Hosp Med 2016; 11 (06) 438-445
    CrossrefPubMedGoogle Scholar
  • 50 Jaff MR, McMurtry MS, Archer SL. et al; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; American Heart Association Council on Peripheral Vascular Disease; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123 (16) 1788-1830
    CrossrefPubMedGoogle Scholar