Abstract 15176: Catheter-Directed-Trombolysis for Acute Massive Pulmonary Embolism with a Novel Modified Tissue Plasminogen Activator
BACKGROUND: Acute massive pulmonary embolism(PE) is a life-threatening condition with high mortality. Survival depands on rapid recanalization of the pulmonary arterial occlusion and reduction of the right ventricular(RV) afterload. The standard medical management for patients with massive PE is systemic thrombolysis using a tissue plasminogen activator(t-PA) or a novel modified t-PA,monteplase. However,systemic thrombolysis is associated with hemorrhagic risk and some patients cannot receive systemic thrombolysis due to contraindications. Catheter directed thrombolysis (CDT) is an alternative therapy for patients with massive PE with contraindications to systemic thrombolysis,and this method is considered to be much less invasive than the open surgery.
PURPOSE: The purpuse of this study was to assess the efficacy and safety of CDT with monteplase.
METHODS AND RESULTS: Between July 2005 and May 2011,38 PE patients(21 females and 17 males, mean age 67 years) were treated using the PIT(pulse-infusion thrombolysis,Senko Medical Instrument, Tokyo, Japan)catheter and recombinant tissue-type plasminogen activator(rt-PA,Monteplase). All patients had RV overload; 6 patients presented in shock. The mean dosage of monteplase was 85.0+/-23.7x104 IU.The mean procedure time was 87.7±18.5 minites. After CDT,significant decrease of mean pulmonary artery pressure(36.4+/-9.4 to 29.5+/-8.2 mmHg:P=0.01) and Miller score(20.1+/-7.7 to 15.3+/-7.4:P=0.03). Furthermore,mean systemic blood pressure increased significantly(93.8+/-22.0 to 100.8+/-22.9 mmHg:P=0.02). Death at 30 days occurred in 3 patients (7.9%). Major bleeding occurred in 1 patients (2.6%). No patients with RV overload at discharge. Follow-up information after discharge was obtained for 35 patients. (mean follow-up 39.9+/-17.5months) All the patients were confirmed survive. Recurrent PE was not observed during follow-up period under anticoaglation.
CONCLUSIONS: CDT with monteplase is an effective and safe therapy for acute massive PE.
- © 2011 by American Heart Association, Inc.