Ultrasound-Assisted, Catheter-Directed Thrombolysis for Acute Intermediate/High-Risk Pulmonary Embolism: Design of the Multicenter USAT IH-PE Registry and Preliminary Results.

Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this study. The primary endpoint was the incidence of pulmonary hypertension (PH) at follow-up. Secondary endpoints were short- and mid-term changes in the echocardiographic parameters of right ventricle (RV) function, in-hospital and all-cause mortality, and procedure-related bleeding events. Between March 2018 and July 2023, 102 patients were included. The majority were at intermediate-high-risk PE (86%), were mostly female (57%), and had a mean age of 63.7 ± 14.5 years, and 28.4% had active cancer. Echocardiographic follow-up was available for 70 patients, and in only one, the diagnosis of PH was confirmed by right heart catheterization, resulting in an incidence of 1.43% (CI 95%, 0.036-7.7). RV echocardiographic parameters improved both at 24 h and at follow-up. In-hospital mortality was 3.9% (CI 95%, 1.08-9.74), while all-cause mortality was 11% (CI 95%, 5.4-19.2). Only 12% had bleeding complications, of whom 4.9% were BARC ≥ 3. Preliminary results from the USAT IH-PE registry showed a low incidence of PH, improvement in RV function, and a safe profile.

[Percutaneous treatment of coronary artery fistula: a tailored strategy is needed]. / Trattamento percutaneo di fistola coronarica: serve una strategia su misura.

Coronary artery fistula (CAF) is a rare, abnormal connection between one or more coronary arteries and a cardiac chamber, or great vessel.We describe the case of a male patient with worsening effort angina referred for coronary angiography. The examination revealed the presence of a CAF between the proximal left anterior descending (LAD) and pulmonary arteries, with mid LAD subocclusive stenosis. Ad hoc PCI with stenting was performed in the mid LAD, followed by CAF embolization with coils and plugs. Angiography and computed tomography scan at follow-up showed complete CAF occlusion, stent patency, and normal flow reserve of the LAD. CAF treatment is indicated only for large or clinically significant symptomatic fistulas. Treatment strategy, technique and device choice should be tailored on CAF anatomical characteristics. In this case, our strategy was feasible, safe and successful with favorable long-term results.