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. 2022 Oct 7;18(8):e623-e638.
doi: 10.4244/EIJ-D-22-00246.

Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

Piotr Pruszczyk  1 , Frederikus A Klok  2   3 , Nils Kucher  4 , Marek Roik  1 , Nicolas Meneveau  5 , Andrew S P Sharp  6 , Jens Erik Nielsen-Kudsk  7 , Slobodan Obradović  8 , Stefano Barco  3   4 , Francesco Giannini  9 , Giulio Stefanini  10   11 , Giuseppe Tarantini  12 , Stavros Konstantinides  3   13 , Dariusz Dudek  9   14
Affiliations

Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

Piotr Pruszczyk et al. EuroIntervention. .

Abstract

There is a growing clinical and scientific interest in catheter-directed therapy (CDT) of acute pulmonary embolism (PE). Currently, CDT should be considered for patients with high-risk PE, in whom thrombolysis is contraindicated or has failed. Also, CDT is a treatment option for initially stable patients in whom anticoagulant treatment fails, i.e., those who experience haemodynamic deterioration despite adequately dosed anticoagulation. However, the definition of treatment failure (primary reperfusion therapy or anticoagulation alone) remains an important area of uncertainty. Moreover, several techniques for CDT are available without evidence supporting one over the other, and variation in practice with regard to periprocedural anticoagulation is considerable. The aim of this position paper is to describe the currently available CDT approaches in PE patients and to standardise patient selection, the timing and technique of the procedure itself as well as anticoagulation regimens during CDT. We discuss several clinical scenarios of the clinical evaluation of the "efficacy" of thrombolysis and anticoagulation, including treatment failure with haemodynamic deterioration and treatment failure based on a lack of improvement. This clinical consensus statement serves as a practical guide for CDT, complementary to the formal guidelines.

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Conflict of interest statement

P. Pruszczyk received consultancy and speaker fees from Boston Scientific, Bayer Healthcare, BMS-Pfizer, Boehringer and travel grants from BMS-Pfizer and Boehringer Ingelheim. F.A. Klok reports research grants from Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Merck Sharp & Dohme, the Netherlands Organisation for Health Research and Development, Actelion, the Dutch Heart foundation, and the Dutch Thrombosis Association, all outside the submitted work. N. Kucher received research funding from the Swiss National Science foundation, the Swiss Heart foundation, and Concept Medical, as well as honoraria from Boston Scientific, Inari, Bard, OptiMed, Bayer and Pfizer. M. Roik received consultancy and speaker fees from Boston Scientific. N. Meneveau received consultancy and speaker fees from Abbott Vascular, Edwards Lifesciences, Terumo, Boston Scientific, Bayer Healthcare, BMS-Pfizer, Boehringer and AstraZeneca; and personal fees from BTG. A.S.P. Sharp received consultancy or speaker fees from Boston Scientific, Medtronic, Recor Medical, Penumbra Inc, and Philips. J.E. Nielsen-Kudsk is a consultant and proctor for Abbott and Boston Scientific. S. Obradović received speaker fees from BMS-Pfizer, Bayer Healthcare, Boehringer, Sanofi, AstraZeneca, Merck Sharp & Dohme and Novartis. S. Barco received consultancy and speaker fees from Bayer, Concept Medical, Boston Scientific, and Inari; and research grants from Bayer, Bard, Boston Scientific, and Bentley. F. Giannini received consultancy and lectures fees from Abbott Vascular, Edwards Lifesciences, Terumo, Boston Scientific, GADA, Abiomed and AstraZeneca. G. Stefanini received a research grant (to the Institution) from Boston Scientific, and speaker and personal fees from Abbott Vascular, Boston Scientific and BMS-Pfizer. G. Tarantini received consultancy and lecture fees from Abbott Vascular, Edwards Lifesciences, Terumo, Boston Scientific, GADA, Abiomed, and AstraZeneca. S. Konstantinides reports institutional research grants from Bayer, Daiichi Sankyo, Boston Scientific, and Inari; and personal consultancy/speaker fees from Bayer, Daiichi Sankyo, Boston Scientific, BMS-Pfizer, and Merck Sharp & Dohme. The other author has no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Treatment efficacy of acute pulmonary embolism.
CPR: cardiopulmonary resuscitation; ECMO: extracorporeal membrane oxygenation; HR: heart rate; RR: respiratory rate; Sat: saturation; SBP: systolic blood pressure
Figure 0
Figure 0. Proposed algorithm and timelines of catheter-directed therapies (CDT) in high-risk and intermediate-high risk pulmonary embolism (PE).
CV: cardiovascular; PERT: Pulmonary Embolism Response Team; TL: thrombolysis
See this image and copyright information in PMC

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