Interventional therapies for pulmonary embolism

• Type of Material: Article
• Authors: Felix Götzinger, Saarland University; Lucas Lauder, Saarland University; Andrew SP Sharp, University Hospital of Wales; Irene M Lang, Medical University of Vienna; Stephan Rosenkranz, Cologne University Heart Center; Stavros Konstantinides, Johannes Gutenberg University of Mainz; Elazer R Edelman, Massachusetts Institute of Technology; Michael Böhm, Saarland University; Wissam Jaber, Emory University; Felix Mahfoud, Saarland University
• Language: English
• Date: 2023-05-12
• Publisher: NATURE PORTFOLIO
• Publication Version: Final Published Version
• Copyright Statement: © Springer Nature Limited 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
• Final Published Version (URL): http://dx.doi.org/10.1038/s41569-023-00876-0
• Title of Journal or Parent Work: NATURE REVIEWS CARDIOLOGY
• Start Page: 1
• End Page: 15
• Keywords: ACTIVATOR RT-PA; DEEP-VEIN THROMBOSIS; Cardiac & Cardiovascular Systems; NORMOTENSIVE PATIENTS; Science & Technology; RANDOMIZED-TRIAL; Cardiovascular System & Cardiology; SEVERITY INDEX; CLINICAL PROGNOSTIC MODEL; RIGHT-VENTRICULAR DYSFUNCTION; Life Sciences & Biomedicine; PLASMINOGEN-ACTIVATOR; VENOUS THROMBOEMBOLISM VTE; CATHETER-DIRECTED THROMBOLYSIS
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Pulmonary embolism (PE) is the leading cause of in-hospital death and the third most frequent cause of cardiovascular death. The clinical presentation of PE is variable, and choosing the appropriate treatment for individual patients can be challenging. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis or surgery; however, a range of percutaneous interventional technologies have been developed that are under investigation in patients with intermediate–high-risk or high-risk PE. These interventional technologies include catheter-directed thrombolysis (with or without ultrasound assistance), aspiration thrombectomy and combinations of the aforementioned principles. These interventional treatment options might lead to a more rapid improvement in right ventricular function and pulmonary and/or systemic haemodynamics in particular patients. However, evidence from randomized controlled trials on the safety and efficacy of these interventions compared with conservative therapies is lacking. In this Review, we discuss the underlying pathophysiology of PE, provide assistance with decision-making on patient selection and critically appraise the available clinical evidence on interventional, catheter-based approaches for PE treatment. Finally, we discuss future perspectives and unmet needs.