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Small-bore aspiration thrombectomy versus catheter-directed thrombolysis in intermediate-high risk acute Pulmonary Embolism
Session:
Posters (Sessão 3 - Écran 7) - Intervenção Coronária e Estrutural 1 - Vários
Speaker:
Mariana Martinho
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana Martinho; Rita Calé; Ana Rita Pereira; Filipa Ferreira; Sofia Alegria; Gonçalo Morgado; Cristina Martins; Melanie Ferreira; Ana Gomes; Tiago Judas; Filipe Gonzalez; Corinna Lohmann; Débora Repolho; Pedro Santos; Ernesto Pereira; Maria José Loureiro; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Introduction</u></strong>: Systemic fibrinolysis failed to prove benefit in intermediate-high risk pulmonary embolism (IHRPE), mainly due to major bleeding complications. As 10% of IHRPE patients (pts) have a higher clinical risk and evolve with haemodynamic (HD) deterioration, percutaneous therapies are emerging as potential treatment options for these pts. Two possible strategies are catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT), but there is a lack of level I evidence for the safety and effectiveness for both of these interventions in IHRPE pts.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Purpose</u></strong>: This study aims to compare the efficacy and safety <span style="color:black">of 2 catheter</span>-directed therapies in IHRPE.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Methods</u></strong>: <span style="color:black">Retrospective </span>single-centre study of consecutive IHRPE pts since 2018 treated with percutaneous therapies. <span style="color:black">CDT was delivered by a 5Fr Cragg-McNamara device (1 mg/h of alteplase) and MT was performed with the Indigo MT system (Penumbra 8Fr).</span> <span style="color:black">Exclusion criteria were HD instability at admission and the use of other reperfusion devices. </span>Clinical success at 48h was defined as survival to hospital discharge and 1 of the following: HD stabilization; oxygenation improvement; decrease in pulmonary hypertension, right heart strain, or both. <span style="color:black">MACE during follow-up (FUP) was defined as a composite endpoint of cardiovascular mortality, PE recurrence, chronic thromboembolic pulmonary hypertension and heart failure hospitalization. Safety endpoint was defined as major bleeding (BARC</span><span style="font-family:Symbol"><span style="color:black">³</span></span><span style="color:black">3).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Results</u></strong>: Of a total of 25 pts, 60% (15pts) were submitted to MT and 40% (10pts) to CDT. The groups had a similar mean age (68.6<span style="font-family:Symbol">±</span>15.6 vs 62.7<span style="font-family:Symbol">±</span>16.4, p=0.381), Charlson Comorbidity Index (4.2<span style="font-family:Symbol">±</span>1.9 vs 2.9<span style="font-family:Symbol">±</span>2.0 points, p=0.121) and PESI score (103.2<span style="font-family:Symbol">±</span>40.6 vs 119.8<span style="font-family:Symbol">±</span>46.2, p=0.410). 80% submitted to CDT received 20mg of alteplase, 1pt 10mg unilaterally and 1pt 50mg due to HD deterioration after the procedure. MT was associated with increased fluoroscopy time (43.0<span style="font-family:Symbol">±</span>19.1 vs 10.1<span style="font-family:Symbol">±</span>6.2 min, p<0.001) and procedure time (115<span style="font-family:Symbol">±</span>63 vs 45<span style="font-family:Symbol">±</span>18 min, p=0.009). Clinical success at 48h was similar (80% in MT vs 90% in CDT; p=0.626). Table 1 shows clinical outcomes regarding each method. Severe adverse events related with the technique<span style="color:black"> happened in 2pts in MT (1 death during the procedure, 1 macroembolization during device progression) and 1pt in CDT group evolved with HD deterioration. </span> Haemoglobin fall was significantly higher in MT group (1.8<span style="font-family:Symbol">±</span>1.3 vs 0.7<span style="font-family:Symbol">±</span>0.8 g/dL, p=0.018), but BARC<span style="font-family:Symbol"><span style="color:black">³</span></span>3 and transfusion rates did not differ. In-hospital mortality was 8% (only 2 pts in the MT group, p=0.229). Mean FUP was 229<span style="font-family:Symbol">±</span>147days, with MT group having significantly higher MACE (40% vs 0%, p=0.051).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u>Conclusions</u></strong>: Despite the similar clinical efficacy at short-term for MT and CDT, relevant adverse events related to the procedure seemed higher in MT group. Larger studies are needed to compare the safety of these techniques. CDT was also less time consuming for catheterization laboratories.</span></span></p>
Slides
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