SPC365

Catheter-Directed Therapies impact on intermediate-high- and high-risk Pulmonary Embolism patients

Session: Comunicações Orais - Sessão 20 - Tromboembolismo pulmonar agudo
Speaker: André Grazina

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: André Grazina; Bárbara Lacerda Teixeira; Luís Almeida Morais; António Fiarresga; Ruben Ramos; Lídia de Sousa; João Reis; Ana Galrinho; Ana Santana; Helena Teles Antunes; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction: </span></strong><span style="color:black">Intermediate-high- and high-risk pulmonary embolism (PE) patients treated with anticoagulation alone are associated with a considerable risk of circulatory collapse, death, or long-term pulmonary hypertension. Pulmonary Embolism Response Teams (PERT) have been created to deliver PE patients a better care. Catheter Directed Therapies (CDT), </span><span style="background-color:white"><span style="color:black">with mechanical thrombolysis and/or local fibrinolysis</span></span><span style="color:black"> allow faster reperfusion and hemodynamic improvement without the systemic hemorrhagic effects of systemic fibrinolysis. </span><span style="background-color:white"><span style="color:black">The clinical evidence of its benefits is lacking.</span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Objectives:</span></strong><span style="color:black"> This analysis aims to describe the hemodynamics, morphological and perfusion improvement in intermediate-high- and high-risk acute PE patients submitted to CDT. </span></span></span></p>

<h1 style="text-align:justify"><span style="font-size:24pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Prospective registry of consecutive intermediate-high- and high-risk PE patients submitted to CDT (mechanical thrombolysis with Penumbra</span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">&nbsp;aspiration system and/or intrapulmonary local fibrinolysis with alteplase) in a single tertiary center. A multiparametric follow-up protocol was designed to evaluate echocardiographic, CT-scan, pulmonary angiogram, and right heart catheterization data at admission and at 3 months after CDT. </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">The paired samples t-Test was used for the analysis of the variables.</span></span></span></span></h1>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Results:</span></span></strong><span style="background-color:white"><span style="color:black"> 26 PE patients (42.3% male, mean age 59 years old) were submitted to CDT (19% combined Penumbra and local fibrinolysis, 12% isolated Penumbra and 69% isolated local fibrinolysis). Baseline characteristics, laboratorial, imaging and procedure data are summarized in the figure 1. No major bleeding was seen during or after the procedure. 1 pulmonary artery dissection and 1 Penumbra burr partial avulsion occurred, both with conservative treatment with good result. 3 patients died during the follow-up (1 for oncologic disease, 1 for septic shock and 1 after discharge with undetermined cause). Of the remaining, 18 patients completed the 3-month follow-up protocol. At 3 months, a significant improvement was seen in the patients&rsquo; hemodynamics with 3.3mmHg mean drop of RA pressure (p 0.007), 16.1mmHg mean drop of systolic PA pressure (p &lt;0.001), 8.0mmHg mean drop of mean PA pressure (p&lt;0.001), 1.4L/min and 0.7L/min/m<sup>2</sup> mean increases in cardiac output and index (p 0.003, p 0.001), and a tendency to a 0.8 Wood units decrease in the pulmonary vascular resistance (p 0.093). It was also seen an improvement in the perfusion defects with a mean drop of 7.9 points in the modified Miller index (p &lt;0.001) and an improvement in the RV function with a mean decrease of 0.5 in the RV/LV ratio by CT-scan (p &lt;0.001), a mean increase of 5.6mm in TAPSE (p &lt;0.001) and a decrease of median NT-proBNP levels in 2866pg/ml (p &lt;0.001).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Conclusions:</span></span></strong><span style="background-color:white"><span style="color:black"> In patients with intermediate-high- and high-risk PE, the use of CDT with mechanical thrombolysis and/or local fibrinolysis is safe and associated with improvement in hemodynamics, RV function and perfusion defects. </span></span></span></span></p>