Browsing by Author "Einarsson, Freyr"

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    Catheter-directed interventions in patients with high-risk pulmonary embolism and contraindication to systemic thrombolysis
    (2020-04-29) Einarsson, Freyr; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
    Abstract Background: Intravenous (iv) thrombolysis is the primary treatment for high-risk pulmonary embolism (PE), but in recent years, catheter-directed interventions (CDI) has emerged as an alternative in patients with contraindications to thrombolysis. Although meta-analyses of CDI have reported high rates of clinical success combined with a low risk of serious adverse events, there is considerable variation in techniques, and very few studies are controlled or randomized. The Sahlgrenska University Hospital introduced CDI a few years ago, and there was a need for evaluation of the results of this treatment. Aims: To evaluate the outcome and effectiveness of the CDI method applied for PE at the Sahlgrenska University Hospital in terms of survival and reduction of right ventricle dilation. Methods: Retrospective study of patients with high-risk PE and contraindication(s) for systemic thrombolysis. We included patients from July 2013, when CDI was introduced, to December 2018. The control cohort consisted of patients from 2006 to 2013, before CDI was introduced, who fulfilled the inclusion criteria but received either heparin or iv thrombolysis. Results: Ninety-day survival was 59% in the CDI group (n=22) and 61% in the control group (n=23). In a linear mixed model, with adjustment for timing of pre- and post-treatment imaging, the decrease of right ventricle/left ventricle (RV/LV) ratio was 0.4 units higher per 24 hours in the CDI group (p=0.007). Conclusions: In this retrospective observational study of patients with high-risk PE and contraindication to thrombolysis, treatment with CDI was as effective as treatment with anticoagulation (or iv thrombolysis) with regards to survival. Moreover, CDI resulted in faster resolution of RV dilation. The latter is to be interpreted with caution since the patients in the CDI group had higher pre-treatment RV/LV ratios.