Journal of Vascular and Interventional Radiology
Volume 20, Issue 11 , Pages 1431-1440 , November 2009

Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism: Systematic Review and Meta-analysis of Modern Techniques

Preliminary data for this study were presented at the SIR 2008 annual meeting.

  • William T. Kuo, MD

      Affiliations

    • Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H-3630, Stanford, CA 94305-5642
    • Corresponding Author InformationAddress correspondence to W.T.K.
    • ,
  • Michael K. Gould, MD, MS

      Affiliations

    • Pulmonary and Critical Care Division, Department of Medicine, Stanford University Medical Center, 300 Pasteur Dr, H-3630, Stanford, CA 94305-5642
    • Pulmonary and Critical Care Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
    • ,
  • John D. Louie, MD

      Affiliations

    • Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H-3630, Stanford, CA 94305-5642
    • ,
  • Jarrett K. Rosenberg, PhD

      Affiliations

    • Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H-3630, Stanford, CA 94305-5642
    • ,
  • Daniel Y. Sze, MD, PhD

      Affiliations

    • Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H-3630, Stanford, CA 94305-5642
    • ,
  • Lawrence V. Hofmann, MD

      Affiliations

    • Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, H-3630, Stanford, CA 94305-5642

Received 18 February 2009 ,Revised 15 July 2009 ,Accepted 3 August 2009.

References 

  1. Heit JA, Cohen AT, Anderson FA. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the U.S. (abstr). Blood. 2005;106:267a
  2. Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008;358:1037–1052
  3. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–1389
  4. Wood KE. Major pulmonary embolism: review of a pathophysiologic approach to the golden hour of hemodynamically significant pulmonary embolism. Chest. 2002;121:877–905
  5. Büller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Anti-thrombotic and Thrombolytic Therapy. Chest. 2004;126:401S–428S
  6. Fiumara K, Kucher N, Fanikos J, Goldhaber SZ. Predictors of major hemorrhage following fibrinolysis for acute pulmonary embolism. Am J Cardiol. 2006;97:127–129
  7. Sackett DL, Strauss SE, Richardson WS, Rosenberg W, Haynes RB. Evidence based medicine: how to practice and teach EBM. 2nd ed.. Edinburgh, Scotland: Churchill Livingstone; 2000;
  8. Staunton M. Evidence-based radiology: steps 1 and 2—asking answerable questions and searching for evidence. Radiology. 2007;242:23–31
  9. Halligan S, Altman DG. Evidence-based practice in radiology: steps 3 and 4—appraise and apply systematic reviews and meta-analyses. Radiology. 2007;243:13–27
  10. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of interventional radiology clinical practice guidelines. J Vasc Interv Radiol. 2003;14:S199–S202
  11. Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69:548–556
  12. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–748
  13. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188
  14. Stuart A, Ord JK. Kendall's advanced theory of statistics. London, England: Edward Arnold; 1994;
  15. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–463
  16. Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000;320:1574–1577
  17. www.gene.com/gene/products/information/cardiovascular/activase/Accessed September 2008
  18. Vedantham S, Grassi CJ, Ferral H, et al. Reporting standards for endovascular treatment of lower extremity deep vein thrombosis. J Vasc Interv Radiol. 2006;17:417–434
  19. Verstraete M, Miller GAH, Bounameaux H, et al. Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism. Circulation. 1988;77:353–360
  20. Schmitz-Rode T, Kilbinger M, Gunther RW. Simulated flow pattern in massive pulmonary embolism: significance for selective intrapulmonary thrombolysis. Cardiovasc Intervent Radiol. 1998;21:199–204
  21. Nakazawa K, Tajima H, Murata S, Kumita SI, Yamamoto T, Tanaka K. Catheter fragmentation of acute massive pulmonary thromboembolism: distal embolisation and pulmonary arterial pressure elevation. B J Radiol. 2008;81:848–854
  22. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.CFMAccessed September 2008
  23. Angiojet Xpeedior [product insert]. In: Minneapolis, Minn: Possis Medical; 2008;p. 1–8
  24. Goldhaber SZ. Percutaneous mechanical thrombectomy for acute pulmonary embolism: a double-edged sword. Chest. 2007;132:363–365
  25. Uflacker R. Interventional therapy for pulmonary embolism. J Vasc Interv Radiol. 2001;12:147–164
  26. Goldhaber SZ. Integration of catheter thrombectomy into our armamentarium to treat pulmonary embolism. Chest. 1998;114:1237–1238
  27. Chamsuddin A, Nazzal L, Kang B, et al. Catheter-directed thrombolysis with the Endowave system in the treatment of acute massive pulmonary embolism: a retrospective multicenter case series. J Vasc Interv Radiol. 2008;19:372–376
  28. Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation. 2005;112:e28–e332
  29. Skaf E, Beemath A, Siddiqui T, Janjua M, Patel NR, Stein PD. Catheter-tip embolectomy in the management of acute massive pulmonary embolism. Am J Cardiol. 2007;99:415–420
  30. Kucher N. Catheter embolectomy for acute pulmonary embolism. Chest. 2007;132:657–663
  31. Schmitz-Rode T, Janssens U, Schild HH, Basche S, Hanrath P, Gunther RW. Fragmentation of massive pulmonary embolism using a pigtail rotation catheter. Chest. 1998;114:1427–1436
  32. Schmitz-Rode T, Janssens U, Duda SH, Erley CM, Gunther RW. Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter. J Am Coll Cardiol. 2000;36:375–380
  33. Muller-Hulsbeck S, Brossmann J, Jahnke T, et al. Mechanical thrombectomy of major and massive pulmonary embolism with use of the Amplatz thrombectomy device. Invest Radiol. 2001;36:317–322
  34. Prokubovsky VI, Kapranov SA, Bobrov BY. Endovascular rotary fragmentation in the treatment of massive pulmonary thromboembolism. Angiol Sosud Khir. 2003;9:31–39
  35. Tajima H, Murata S, Kumazaki T, et al. Hybrid treatment of acute massive pulmonary thromboembolism: mechanical fragmentation with a modified rotating pigtail catheter, local fibrinolytic therapy, and clot aspiration followed by systemic fibrinolytic therapy. AJR Roentgenol. 2004;183:589–595
  36. Barbosa MA, Oliveira DC, Barbosa AT, et al. Treatment of massive pulmonary embolism by percutaneous fragmentation of the thrombus. Arq Bras Cardiol. 2008;88:279–284
  37. Brady AJB, Crake T. Percutaneous catheter fragmentation and distal dispersion of proximal pulmonary embolus. Lancet. 1991;338:1186–1189
  38. Rafique M, Middlemost S, Skoularigis J, Sareli P. Simultaneous mechanical clot fragmentation and pharmacologic thrombolysis in acute massive pulmonary embolism. Am J Cardiol. 1992;69:427–430
  39. Uflacker R, Strange C, Vujic I. Massive pulmonary embolism: preliminary results of treatment with the Amplatz thrombectomy device. J Vasc Interv Radiol. 1996;7:519–528
  40. Fava M, Loyola S, Huete I. Mechanical fragmentation and pharmacologic thrombolysis in massive pulmonary embolism. J Vasc Interv Radiol. 1997;8:261–266
  41. Stock KW, Jacob AL, Schnabel KJ, Bongartz G, Steinbrich W. Massive pulmonary embolism: treatment with thrombus fragmentation and local fibrinolysis with recombinant human-tissue plasminogen activator. Cardiovasc Interven Radiol. 1997;20:364–368
  42. Basche S, Oltmanns G. Thrombus fragmentation in massive pulmonary embolism. Die Medizinische Welt. 1997;48:325–327
  43. Hiramatsu S, Ogihara A, Kitano Y, et al. Clinical outcome of catheter fragmentation and aspiration therapy in patients with acute pulmonary embolism. J Cardiol. 1999;34:71–78
  44. Wong PS, Singh SP, Watson RD, Lip GY. Management of pulmonary thrombo-embolism using catheter manipulation: a report of four cases and review of the literature. Postgrad Med J. 1999;75:737–741
  45. Murphy JM, Mulvihill N, Mulcahy D, Foley B, Smiddy P, Molloy MP. Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism. Eur Radiol. 1999;9:959–964
  46. Voigtlander T, Rupprecht HJ, Nowak B, et al. Clinical application of a new rheolytic thrombectomy catheter system for massive pulmonary embolism. Catheter Cardiovasc Interv. 1999;47:91–96
  47. Fava M, Loyola S, Huete I. Massive pulmonary embolism: treatment with the hydrolyser thrombectomy catheter. J Vasc Interv Radiol. 2000;11:1159–1164
  48. Egge J, Berentsen S, Storesund B, Rod R, Waage K. Treatment of massive pulmonary embolism with local thrombolysis. Tidsskr Nor Laegeforen. 2002;122:2263–2266
  49. De Gregorio MA, Gimeno MJ, Mainar A, et al. Mechanical and enzymatic thrombolyis for massive pulmonary embolism. J Vasc Interv Radiol. 2002;13:163–169
  50. Zeni PT, Blank BG, Peeler DW. Use of rheolytic thrombectomy in treatment of acute massive pulmonary embolism. J Vasc Interv Radiol. 2003;14:1511–1515
  51. Reekers JA, Baarslag HJ, Koolen MGJ, Delden OV, van Beek EJR. Mechanical thrombectomy for early treatment of massive pulmonary embolism. Cardiovasc Intervent Radiol. 2003;26:246–250
  52. Tajima H, Murata S, Kumazaki T, et al. Hybrid treatment of acute massive pulmonary thromboembolism: mechanical fragmentation with a modified rotating pigtail catheter, local fibrinolytic therapy, and clot aspiration followed by systemic fibrinolytic therapy. Radiat Med. 2004;22:168–172
  53. Fava M, Loyola S, Bertoni H, Dougnac A. Massive pulmonary embolism: percutaneous mechanical thrombectomy during cardiopulmonary resuscitation. J Vasc Interv Radiol. 2005;16:119–123
  54. Siablis D, Karnabatidis D, Katsanos K, Kagadis GC, Zabakis P, Hahalis G. AngioJet rheolytic thrombectomy versus local intrapulmonary thrombolysis in massive pulmonary embolism: a retrospective data analysis. J Endovasc Ther. 2005;12:206–214
  55. Yoshida M, Inoue I, Kawagoe T, et al. Novel percutaneous catheter thrombectomy in acute massive pulmonary embolism: rotational bidirectional thrombectomy (ROBOT). Catheter Cardiovasc Interv. 2006;68:112–117
  56. Li J, Zhai R, Dai D, Gao K, Wei B, Wang C. Interventional mechanical thrombectomy procedure in treating acute massive pulmonary infarction. J Interv Radiol. 2006;15:336–338
  57. Pieri S, Agresti P. Hybrid treatment with angiographic catheter in massive pulmonary embolism: mechanical fragmentation and fibrinolysis. Radiol Med. 2007;112:837–849
  58. Chauhan MS, Kawamura A. Percutaneous rheolytic thrombectomy for large pulmonary embolism: a promising treatment option. Catheter Cardiovasc Interv. 2007;70:121–128
  59. Krajina A, Lojik M, Chovanec V, et al. Percutaneous mechanical fragmentation of emboli in the pulmonary artery. Ces Radiol. 2007;61:162–166
  60. Yang Z, Shi H, Li L, Liu S. System thrombolysis combined with percutaneous catheter fragmentation and thrombectomy in acute massive pulmonary embolism. Chin J Radiol. 2007;41:1241–1244
  61. Margheri M, Vittori G, Vecchio S, et al. Early and long-term clinical results of Angiojet rheolytic thrombectomy in patients with acute pulmonary embolism. Am J Cardiol. 2008;101:252–258
  62. Vecchio S, Vittori G, Chechi T, et al. Percutaneous rheolytic thrombectomy with AngioJet for pulmonary embolism: methods and results in the experience of a high-volume center. It J Practice Cardiol. 2008;9:355–363
  63. Chen L, Gu J, Lou W, et al. Interventional mechanical thrombectomy for acute pulmonary embolism. J Vasc Interv Radiol. 2008;17:468–471
  64. Eid-Lidt G, Gaspar J, Sandoval J, et al. Combined clot fragmentation and aspiration in patients with acute pulmonary embolism. Chest. 2008;134:54–60
  65. Kuo WT, Van den Bosch MA, Hofmann LV, Louie JD, Kothary N, Sze DY. Catheter-directed embolectomy, fragmentation, and thrombolysis for the treatment of massive pulmonary embolism after failure of systemic thrombolysis. Chest. 2008;134:250–254

 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.

PII: S1051-0443(09)00802-1

doi: 10.1016/j.jvir.2009.08.002

Journal of Vascular and Interventional Radiology
Volume 20, Issue 11 , Pages 1431-1440 , November 2009

Article Tools

* Image Usage & Resolution