Catheter directed interventions for pulmonary embolism: current status and future prospects

ABSTRACT

Introduction: Catheter directed interventions (CDIs) have evolved over the past decade in an attempt to reduce the complications of systemic thrombolysis, while providing equivalent therapeutic benefits.

Areas covered: CDIs include a wide array of catheters that incorporate ultrasound technology, the infusion of thrombolytics through multi-side hole catheters and suction thrombectomy systems. We present a contemporary review summarizing the different catheter directed interventions currently available for acute PE, their indications, technical considerations, clinical effectiveness, complication rates and long-term outcomes.

Expert opinion: For intermediate high-risk PE patients without a contraindication for thrombolysis, CDIs should be considered in patients at risk for clinical decompensation. For high risk PE patients with a major contraindication to thrombolytic therapy, suction thrombectomy can be considered in places with appropriate clinical and technical expertise.

KEYWORDS:

• Pulmonary Embolism
• Catheter directed interventions
• Thrombolysis
• suction thrombectomy
• catheter thrombolysis

Article Highlights

• CDI have been promoted for use in both intermediate and high-risk PE in an attempt to reduce the complication rates of systemic thrombolytics.

• For intermediate high-risk PE patients without a contraindication for thrombolysis, catheter thrombolysis should be considered in patients at risk for clinical decompensation.

• For high risk PE patients with a major contraindication to thrombolytic therapy, suction thrombectomy can be considered in places with appropriate expertise.

• Multidisciplinary teams are required to better identify the patient population that might benefit most from these invasive interventions.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.