E-ISSN 1305-3612
Interventional Radiology - Original Article
Value of follow-up angiography: additional interventions in patients undergoing catheter-directed thrombolysis for massive and submassive pulmonary embolism
1 Division of Interventional Radiology, Department of Radiology, Rush University School of Medicine, Chicago, IL  
2 Division of Interventional Radiology, Department of Radiology, Northwestern Medicine, Chicago, IL  
Diagn Interv Radiol ; : -

Abstract

PURPOSE: Catheter-directed thrombolysis (CDT) is an emerging, minimally invasive treatment for patients with massive and submassive PE. The value of follow-up pulmonary angiography for evaluating improvement after CDT is limited by a paucity of large studies assessing its utility and role for additional intervention. The purpose of our study was to assess the role of next-day pulmonary angiography for catheter-directed thrombolysis (CDT) in patients with acute massive and submassive PE undergoing continuous pulmonary arterial pressure monitoring, and secondarily, determine factors that are correlated with a need for further therapy.

 

METHODS: Patients undergoing CDT from 2006-2016 for massive and submassive PE were reviewed. Patient demographics, co-morbidities, pre-procedural labs, non-invasive hemodynamic studies, and technical variables were recorded. Among patients receiving next-day angiography, those requiring further therapy, defined as continued CDT beyond the standard 24 hours (with or without catheter repositioning or exchange) and/or mechanical or suction thrombectomy were contrasted with those not requiring additional therapy to assess for the role of angiography and patient factors that correlate with need for further therapy.

               

RESULTS: Thirty-two patients underwent CDT for massive (n=14) and submassive (n=18) PE. Eighteen (56.3%) were male, 14 (43.7%) were Caucasian, 18 (56.3%) were African-American, with a mean age of 66.2 years (range, 26 to 87). Of the 27 (84.4%) patients that underwent next-day pulmonary angiography, 16 (59.3%) did not require additional therapy and 11 (40.7%) did require additional therapy. Additional therapy included extended CDT beyond 24 hours (n=4), mechanical/suction thrombectomy (n=5), or both extended CDT and mechanical/suction thrombectomy (n=2). Younger age (50.1 vs 62.2 years, P = 0.039) was correlated with a need for further therapy. Initial (40.7 vs 34.8, P = 0.248), next-day (31.5 vs 26.3, P = 0.259), and interval change (4.6 vs 8.0, P = 0.669) in pulmonary artery pressures (mmHg) were not statistically significant between patient subsets. Pre-procedural RV/LV size also did not differ significantly (1.74 vs 1.75, P=0.961). 30-day mortality were comparable (2 vs 1, P = 0.332).

 

CONCLUSION: Next-day pulmonary angiography is a useful method to identify patients needing additional therapy including extended CDT and/or mechanical or suction thrombectomy in acute PE management. Pulmonary arterial pressures and pre-procedural RV/LV ratios were not found to be predicative of those requiring further intervention.

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