Contemporary Catheter-Based Treatment Options for Management of Acute Pulmonary Embolism

Abstract

Introduction: Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients.

Purpose of review: The purpose of this review is to familiarize the clinicians with (1) various types of catheter-based modalities available for patients with acute PE, (2) advantages, disadvantages, and appropriate patient selection for the use of these devices, and (3) evidence base and the relevance of such therapies in the COVID-19 pandemic.

Recent findings: There are four main types of catheter-based therapies in acute PE: (1) standard catheter-directed thrombolysis (CDT), (2) ultrasound-assisted CDT, (3) pharmacomechanical CDT, and (4) mechanical thrombectomy without thrombolysis. Ultrasound-assisted thrombolysis is the most widely studied modality in this group; however, evidence base for other catheter-based technologies is rapidly emerging.

Summary: Current use of catheter-based therapies is most suitable for patients with intermediate and high-risk acute PE. The adoption of a multidisciplinary approach like the pulmonary embolism response team (PERT) is desirable for appropriate patient selection and possibly/potentially improving patient outcomes. We discuss the current status of these therapies.

Keywords: Acute pulmonary embolism; COVID-19; Catheter-directed thrombolysis; Endovascular therapy; Pulmonary embolism response team.

Fig. 1

Bashir endovascular catheter device.

Fig. 2

Algorithm for management of patients with acute PE. PERT = pulmonary embolism response team, CDT = catheter-directed thrombolysis, VA-ECMO = veno-arterial extracoporeal membrane oxygenation, RV = right ventricular, PE = pulmonary embolism.