EkoSonic® endovascular system and other catheter-directed treatment reperfusion strategies for acute pulmonary embolism: overview of efficacy and safety outcomes

ABSTRACT

Introduction

Studies performed in the past decade suggested that evolving reperfusion strategies may improve early outcomes of patients with acute pulmonary embolism (PE) and hemodynamic decompensation. In this regard, catheter-directed treatment (CDT) options are receiving increasing attention.

Areas covered

A broad spectrum of CDT options exists for the treatment of patients with acute PE. Procedures include catheter-directed local thrombolysis with or without ultrasound assistance, catheter-directed mechanical or suction embolectomy, and combined pharmaco-mechanical approaches. We present here an overview of the available CDT techniques, focusing on the EkoSonic® endovascular system.

Expert commentary

CDT, particularly local ultrasound accelerated thrombolysis, continues to evolve. Its increasing popularity is the result of accumulating promising results, which suggest a relief of right ventricular (RV) pressure overload and improvement of RV function. These favorable effects on surrogate endpoints were accompanied by a low rate of procedure-related adverse events, notably intracranial hemorrhage. Although the overall risk of serious bleeding appears to be low in CDT, the lack of direct comparisons with other reperfusion options does not allow definitive conclusions. Prospective controlled trials with robust clinical outcomes are urgently needed to establish the postulated benefits of CDT in selected patients with acute PE.

KEYWORDS:

• Pulmonary embolism
• catheter-directed treatment
• ultrasound-accelerated thrombolysis
• Ekosonic® endovascular system

Reviewer disclosures

One peer reviewer has done consultancy work for BTG/Boston Scientific. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Declaration of interest

L. Hobohm reports lecture/consultant fees from MSD and Actelion, outside the submitted work. K. Keller reports no conflict of interest. T. Münzel reports no conflict of interest. T. Gori reports having received consultancy and lecture honoraria from Abbott Vascular and Boston Scientific, outside the submitted work. S. V. Konstantinides reports grants and personal fees from Bayer AG; research grants from Boehringer Ingelheim and Servier; research grants and personal fees from Actelion, Daiichi-Sankyo, and Biocompatibles Group – Boston Scientific; personal fees from Pfizer-Bristol-Myers Squibb and MSD, all outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.