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Review
. 2015 Dec;32(4):384-7.
doi: 10.1055/s-0035-1564707.

Endovascular Management of Acute Pulmonary Embolism Using the Ultrasound-Enhanced EkoSonic System

Mark J Garcia  1
Affiliations
Review

Endovascular Management of Acute Pulmonary Embolism Using the Ultrasound-Enhanced EkoSonic System

Mark J Garcia. Semin Intervent Radiol. 2015 Dec.

Abstract

Acute, symptomatic pulmonary embolism (PE) in the massive and submassive categories continues to be a healthcare concern with significant risk for increased morbidity and mortality. Despite increased awareness and venous thromboembolism prophylaxis, endovascular treatment is still an important option for many of these patients. There are a variety of techniques and devices used for treating PE, but none have been evaluated as extensively as the EkoSonic endovascular system that is also currently the only FDA-approved device for the treatment of pulmonary embolism. This article describes the use of the EkoSonic device for this patient population.

Keywords: EKOS; endovascular treatment; interventional radiology; pulmonary embolism; ultrasound-enhanced thrombolysis.

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Figures

Fig. 1
Fig. 1
(a) The EkoSonic Mach 4E Endovascular System with larger infusion catheter (arrow) and removable inner core wire with ultrasound transducers (arrowhead). (b) Schlieren photograph of acoustic streaming from the EkoSonic catheter emitting ultrasound energy (image courtesy of EKOS-BTG).
Fig. 2
Fig. 2
(a–d) Contrast-enhanced coronal images from a pulmonary CTA demonstrating an extensive saddle pulmonary embolism extending from right to left pulmonary arteries (arrowheads) and extending into the right and left central and subsegmental braches. (e) Axial image from the CTA demonstrates right heart strain with bowing out of the interventricular septum toward the left, with the right ventricular/left ventricular ratio of 1.4.
Fig. 3
Fig. 3
(a) Selected right pulmonary angiogram demonstrates extensive thrombus in all branches of the right pulmonary artery (arrows), with pruning of the distal branches and poor parenchymal perfusion. (b) Radiograph demonstrating appropriate placement of the bilateral pulmonary EKOS catheters (arrows).
Fig. 4
Fig. 4
12-hour follow-up pulmonary angiograms post–EKOS infusion in early (a) and delayed (b) phases demonstrate interval thrombolysis bilaterally with significantly improved pulmonary perfusion and associated decreases in right ventricular and pulmonary pressures as well as the right ventricular/left ventricular ratio.
See this image and copyright information in PMC

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