Interventional therapies in acute pulmonary embolism

Abstract

Pulmonary embolism (PE) is the third most frequent cause of cardiovascular mortality and a frequent preventable complication in hospitalized patients. In recent years, several catheter- directed interventions (CDI) strategies and devices for treating acute PE have emerged, such as local thrombolysis, ultrasound-facilitated local thrombolysis, and medium- and large-bore aspiration catheters. Each device has different advantages and supporting literature, and thus, the choice should be individualized. Interventional treatment for PE is based on risk stratification, with current guidelines positioning CDI as a rescue treatment for high-risk PE patients in whom systemic thrombolysis has failed or is contraindicated and for intermediate-high-risk PE patients with clinical deterioration despite anticoagulation. However, clinical practice and several consensus documents favor a more invasive approach with CDI, anticipating clinical deterioration in patients at risk. This review outlines the available CDI options, the scientific evidence supporting these therapies, and the clinical scenarios in which they could be used.

Keywords

• Embolectomy. Fibrinolytic therapy. Percutaneous aspiration thrombectomy. Pulmonary embolism. Therapeutic thrombolysis.