PULMONARY THROMBECTOMY WITH CATHETER FOR THE TREATMENT OF ACUTE PULMONARY EMBOLISM: A LOCAL PROTOCOL

ABSTRACT

In February 2021, a PDTA on Pulmonary Embolism (PE) was approved in our hospital, including a chapter describing a protocol for the treatment with catheter thrombectomy (CT) of patients with high and intermediate risk PE. The protocol took into account the recommendations of the ESC 2019 guidelines on PE, and was produced to describe a path to improve the treatment of patients with PE It included a) thrombectomy with aspiration in patients high-risk patients, with no haemodynamic improvement after administration of systemic thrombolytic therapy (TT) or with absolute contraindication to it;b) thrombectomy with loco-regional ultrasound-assisted thrombolysis (USAT) in patients at high-intermediate risk. 20 patients were treated from February 2020 to September 2021. 55% were men, with an average age of 73 ± 13 years;all patients met the criteria for inclusion in the protocol and signed a consensus document. 2 high-risk patients were treated with thromboaspiration one patient for absolute contraindication to TT (recent spontaneous brain haemorrhage), the other one for a syncopal episode with head trauma. 18 patients (92%) at high intermediate risk were treated with USAT. For the 90% of patients were used 2 catheters;in 72% the administered dose of rt-PA was 24 mg. The mean value of NT- proBNP was 2,896 ng/l (normal m<93, f<144) There was only one major bleeding complication in the high-intermediate risk group (macrohematuria) during hospitalization. The mean RV/LV ratio was 1.48 (± 0.14) at baseline and 0.85 (± 0.14) at 48 hours with a reduction of 43%. The 2 high-risk patients died one 1 month after the procedure, due to the effects of cerebral haemorrhage, the other one after 10 days due to respiratory complications. The mean FU of 17 patients was 228 days (± 193);during the FU there was a recurrence of PE (6%) after the discontinuation of anticoagulant therapy;there were no haemorrhages. RV dysfunction persisted in one patient (6%) with CTEPH who subsequently underwent pulmonary endarterectomy. Conclusion: PDTA and teamwork helped to improve the therapeutic decision making in patients with PE at a high and intermediate-high risk, despite the difficulties due to the SARS-COV-2 pandemic. Our experience was found to be in line with what has been published on the efficacy and safety of CT. (Figure Presented).