Clinical studyCatheter-directed Therapy for the Treatment of Massive Pulmonary Embolism: Systematic Review and Meta-analysis of Modern Techniques
Section snippets
Materials and Methods
We performed a systematic review by searching electronic databases (MEDLINE, EMBASE) for studies published from January 1990 through September 2008 and by reviewing reference lists of retrieved studies. The study was conducted by using the framework of evidence-based medicine outlined by the McMaster University and National Health Service Centre for Evidence Based Medicine group (7) and published guidelines for integrating current best evidence and clinical expertise (8, 9). The following
Results
A total of 594 patients from 35 uncontrolled studies–six prospective, 29 retrospective–met criteria for inclusion, and the data were identified from 18 countries (Table 2). There were no disagreements among reviewers who selected studies for inclusion. Because they were uncontrolled, all studies were graded as level 2 evidence. Data on the use of systemic thrombolysis before CDT were available in 571 patients. From this subgroup, 546 of the 571 patients (96%) did not receive systemic
Discussion
Despite improvements in the prevention, diagnosis, and treatment of venous thromboembolism, acute PE remains an important clinical problem with a high mortality rate. For patients requiring treatment beyond heparin anticoagulation, systemic thrombolytic therapy is currently indicated for acute massive PE accompanied by unstable hemodynamics (5). However, systemic thrombolysis is also associated with several absolute and relative contraindications (17), and sufficient time (at least 2 hours) is
References (65)
- et al.
Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)
Lancet
(1999) Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism
Chest
(2002)- et al.
Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Anti-thrombotic and Thrombolytic Therapy
Chest
(2004) - et al.
Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism
Am J Cardiol
(2006) - et al.
Society of interventional radiology clinical practice guidelines
J Vasc Interv Radiol
(2003) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Reporting standards for endovascular treatment of lower extremity deep vein thrombosis
J Vasc Interv Radiol
(2006) Percutaneous mechanical thrombectomy for acute pulmonary embolism: a double-edged sword
Chest
(2007)Interventional therapy for pulmonary embolism
J Vasc Interv Radiol
(2001)Integration of catheter thrombectomy into our armamentarium to treat pulmonary embolism
Chest
(1998)
Catheter-directed thrombolysis with the Endowave system in the treatment of acute massive pulmonary embolism: a retrospective multicenter case series
J Vasc Interv Radiol
Catheter-tip embolectomy in the management of acute massive pulmonary embolism
Am J Cardiol
Catheter embolectomy for acute pulmonary embolism
Chest
Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter
J Am Coll Cardiol
Percutaneous catheter fragmentation and distal dispersion of proximal pulmonary embolus
Lancet
Massive pulmonary embolism: preliminary results of treatment with the Amplatz thrombectomy device
J Vasc Interv Radiol
Mechanical fragmentation and pharmacologic thrombolysis in massive pulmonary embolism
J Vasc Interv Radiol
Massive pulmonary embolism: treatment with the hydrolyser thrombectomy catheter
J Vasc Interv Radiol
Mechanical and enzymatic thrombolyis for massive pulmonary embolism
J Vasc Interv Radiol
Use of rheolytic thrombectomy in treatment of acute massive pulmonary embolism
J Vasc Interv Radiol
Massive pulmonary embolism: percutaneous mechanical thrombectomy during cardiopulmonary resuscitation
J Vasc Interv Radiol
Early and long-term clinical results of Angiojet rheolytic thrombectomy in patients with acute pulmonary embolism
Am J Cardiol
Combined clot fragmentation and aspiration in patients with acute pulmonary embolism
Chest
Catheter-directed embolectomy, fragmentation, and thrombolysis for the treatment of massive pulmonary embolism after failure of systemic thrombolysis
Chest
Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the U.S. (abstr)
Blood
Acute pulmonary embolism
N Engl J Med
Evidence based medicine: how to practice and teach EBM
Evidence-based radiology: steps 1 and 2—asking answerable questions and searching for evidence
Radiology
Evidence-based practice in radiology: steps 3 and 4—appraise and apply systematic reviews and meta-analyses
Radiology
Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature
Am Fam Physician
Statistical aspects of the analysis of data from retrospective studies of disease
J Natl Cancer Inst
Kendall's advanced theory of statistics
Cited by (0)
D.Y.S. is a consultant for MediGene, Inc. and Jennerex Biotherapeutics, Inc. He is on the medical advisory board for Lunar Design, Inc., and he is a shareholder of Nitinol Devices and Components, Inc. None of these are related to the subject matter of this article. L.V.H. is on the scientific advisory board for Bacchus Vascular and Portola Pharmaceuticals. He is a speaker for Cook. None of these are related to the subject matter of this article. None of the other authors have identified a conflict of interest.