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Pulmonary embolism reperfusion

Hajime Kasai, Sugiura Toshihiko, Takayuki Kobayashi, Risa Okamura, Masayuki Oota, Nao Harada, Yoshinobu Wada, Satoshi Oota, Ichiro Yoshino, Yukio Nakatani, Koichiro Tatsumi
Recurrence of an embolized pulmonary arteriovenous malformation (PAVM) is common after coil embolization. A 23-year-old woman who had undergone multiple instances of transcatheter coil embolization was admitted with hypoxia and hemoptysis. A PAVM in the left S6 was found to be recanalized by reperfusion through the pulmonary and bronchial arteries. The left S6 was partially resected; the specimen contained necrotic granulomas and non-tuberculous mycobacteria (NTM) around the PAVM. Clinicians should consider possible recurrence of PAVM after reperfusion of the pulmonary and bronchial arteries, as well as the risk of NTM infection during follow-up of patients who have undergone repeated coil embolization...
February 1, 2019: Internal Medicine
Karsten Keller, Lukas Hobohm, Thomas Münzel, Mir Abolfazl Ostad
BACKGROUND: Atherosclerosis is associated with increased cardiovascular mortality. Associations between venous thromboembolism and atherosclerosis were recently reported. We aimed to investigate the impact of symptomatic atherosclerosis on adverse outcomes in patients with pulmonary embolism (PE) and to identify significant differences among patients with PE stratified by symptomatic atherosclerosis. METHODS: Patients were selected by screening the nationwide inpatients sample for PE (ICD-code I26) stratified by symptomatic atherosclerosis (composite of coronary artery disease [ICD-code I25], myocardial infarction [ICD-code I21], ischemic stroke [ICD-code I63], and/or atherosclerotic arterial diseases [ICD-code I70])...
December 6, 2018: International Journal of Cardiology
Mateo Porres-Aguilar, Javier E Anaya-Ayala, Gustavo A Heresi, Belinda N Rivera-Lebron
Pulmonary embolism represents the third most common cause of cardiovascular death in the United States. Reperfusion therapeutic strategies such as systemic thrombolysis, catheter directed therapies, surgical pulmonary embolectomy, and cardiopulmonary support devices are currently available for patients with high- and intermediate-high-risk pulmonary embolism. However, deciding on optimal therapy may be challenging. Pulmonary embolism response teams have been designed to facilitate multidisciplinary decision-making with the goal to improve quality of care for complex cases with pulmonary embolism...
November 19, 2018: Clinical and Applied Thrombosis/hemostasis
Stefano Barco, Stavros V Konstantinides
Pulmonary embolism (PE) contributes substantially to the global disease burden. A key determinant of early adverse outcomes is the presence (and severity) of right ventricular dysfunction. Consequently, risk-adapted management strategies continue to evolve, tailoring acute treatment to the patients' clinical presentation, hemodynamic status, imaging and biochemical markers, and comorbidity. For subjects with hemodynamic instability or 'high-risk' PE, immediate systemic reperfusion treatment with intravenous thrombolysis is indicated; emerging approaches such as catheter-directed pharmacomechanical reperfusion might help to minimize the bleeding risk...
September 25, 2018: Annals of Vascular Diseases
Stefano Barco, Stavros V Konstantinides
Acute pulmonary embolism (PE) contributes significantly to the global burden of cardiovascular disease. The severity of the acute PE event determines the expected estimated risk of early death. This risk is influenced by the degree of dysfunction of the right ventricle (RV), as assessed by the presence of acute RV pressure overload on imaging and/or elevated cardiac biomarkers, and by demographic and clinical factors, including relevant comorbidities. Haemodynamic instability and cardiogenic shock is at the top of the PE severity spectrum, as it represents the most extreme manifestation of RV failure and a key determinant of poor prognosis...
October 18, 2018: Hämostaseologie
Fei Teng, Yun-Xia Chen, Xin-Hua He, Shu-Bin Guo
Background: The quick Sequential Organ Failure Assessment (qSOFA) score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism (PE) by combining with electrocardiography (ECG). Methods: Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low - risk groups by imaging and biomarkers. The ECG scores consisted of tachycardia, McGinn-White sign (S1 Q3 T3 ), right bundle branch block, and T-wave inversion of leads V1 -V3 ...
October 20, 2018: Chinese Medical Journal
Michael R Kendall, Stuart Swadron, Leonardo C Clavijo, Anilkumar K Mehra, Antotreas Hindoyan, Ray V Matthews, David M Shavelle
BACKGROUND: Patients with massive and submassive pulmonary embolism (PE) require rapid identification, triage, and consideration for reperfusion therapy. Use of an existing ST-segment elevation myocardial infarction (STEMI) team and activation protocol may be an effective means to care for these patients. OBJECTIVE: The objective of this analysis was to evaluate a pilot study using the STEMI team and a dedicated PE protocol for treatment of patients with massive and submassive PE...
October 2018: Journal of Invasive Cardiology
Nicolas Meneveau
The therapeutic strategy of acute pulmonary embolism (PE) is based on risk stratification of early mortality in the emergency department. Anticoagulant therapy should be given to all PE patients as early as possible, and direct oral anticoagulants are expected to replace vitamin K antagonists in the majority of cases. The use of a reperfusion strategy should always be considered in patients with high-risk PE defined as PE with clinical hemodynamic instability. Surgical or percutaneous embolectomy is an alternative in case of contraindication to thrombolytic therapy in these patients...
September 2018: La Presse Médicale
Alexandru Burlacu, Bogdan Artene, Adrian Covic
PURPOSE: A timely pharmacoinvasive strategy consisting of thrombolytic therapy (TT) plays a pivotal role in three major scenarios: acute ischemic stroke (AIS), acute myocardial infarction (STEMI), and massive pulmonary embolism (PE). Presence of advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m2), known to disturb thrombotic/thrombolytic equilibrium, causes difficulties for clinicians in evaluating risk-benefit balance, as current guidelines do not address the relationship between TT and the advanced CKD...
October 2018: Cardiovascular Drugs and Therapy
Nicolas Meneveau, Benoit Guillon, Benjamin Planquette, Gaël Piton, Antoine Kimmoun, Lucie Gaide-Chevronnay, Nadia Aissaoui, Arthur Neuschwander, Elie Zogheib, Hervé Dupont, Sebastien Pili-Floury, Fiona Ecarnot, François Schiele, Nicolas Deye, Nicolas de Prost, Raphaël Favory, Philippe Girard, Mircea Cristinar, Alexis Ferré, Guy Meyer, Gilles Capellier, Olivier Sanchez
Aims: The role of extracorporeal membrane oxygenation (ECMO) remains ill defined in pulmonary embolism (PE). We investigated outcomes in patients with high-risk PE undergoing ECMO according to initial therapeutic strategy. Methods and results: From 01 January 2014 to 31 December 2015, 180 patients from 13 Departments in nine centres with high-risk PE were retrospectively included. Among those undergoing ECMO, we compared characteristics and outcomes according to adjunctive treatment strategy (systemic thrombolysis, surgical embolectomy, or no reperfusion therapy)...
December 14, 2018: European Heart Journal
Andrzej S Pitek, Jooneon Park, Yunmei Wang, Huiyun Gao, He Hu, Daniel I Simon, Nicole F Steinmetz
Cardiovascular thrombotic disease is an underlying cause of stroke, myocardial infarction and pulmonary embolism - some of the leading causes of death worldwide. Reperfusion therapy with anticoagulant, antiplatelet, and fibrinolytic agents has significantly reduced early mortality and morbidity from acute myocardial infarction and stroke. Nevertheless, bleeding side effects (e.g., intracranial hemorrhage) associated with the anti-thrombotic therapy can offset its benefits and limit its applicability to strictly defined short therapeutic windows...
September 13, 2018: Nanoscale
Miyuki Maruno, Hiro Kiyosue, Norio Hongo, Shunro Matsumoto, Hiromu Mori
PURPOSE: Reperfusion via pulmonary-to-pulmonary arterial anastomoses is known as one type of recurrence of pulmonary arteriovenous malformations (PAVMs) after embolization. It is important to occlude the fistulous portion beyond the origin of the last normal branch from feeding artery of PAVMs to prevent recurrence. In this study, we evaluate the origin of the last normal branch by CT as well as its visibility on pulmonary arteriography (PAG). MATERIALS AND METHODS: We reviewed forty patients with 77 PAVMs who underwent coil embolization between October 2007 and December 2017...
December 2018: Cardiovascular and Interventional Radiology
David Jiménez, Behnood Bikdeli, Deisy Barrios, Andrés Quezada, Jorge Del Toro, Gemma Vidal, Isabelle Mahé, Isabelle Quere, Mónica Loring, Roger D Yusen, Manuel Monreal
BACKGROUND: Limited information exists about the epidemiology, management and outcomes of hemodynamically unstable patients with acute pulmonary embolism (PE). We aimed to evaluate the prevalence and outcomes of unstable PE, and to assess the acute management in routine clinical practice. METHODS: This study included 34,380 patients from the RIETE registry with PE between 2001 and 2016. Primary outcomes included all-cause and PE-specific 30-day mortality. We used multivariable adjustments to calculate hazard ratios among unstable patients who did and did not receive reperfusion...
October 15, 2018: International Journal of Cardiology
Sergio Nappini, Nicola Limbucci, Giuseppe Leone, Andrea Rosi, Leonardo Renieri, Arturo Consoli, Antonio Laiso, Iacopo Valente, Francesco Rosella, Riccardo Rosati, Salvatore Mangiafico
BACKGROUND: Recent trials established the efficacy of mechanical stent-retriever thrombectomy for treatment of stroke patients with large vessel occlusion (LVO) in the anterior circulation. However, stent-retriever thrombectomy may not accomplish successful recanalization in all patients. The aim of this study is to report the role of bail-out permanent stenting after failure of mechanical thrombectomy. METHODS: Among 430 patients included in a prospectively maintained database, we analysed 325 cases of anterior circulation LVO...
June 18, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Christian Degen, Severin Poechtrager, Gregor Leibundgut
We present a case of a 72-year-old man with submassive acute pulmonary thromboembolism. Pulmonary embolism severity index Score and common clinical risk stratification recommended systemic anticoagulation and a clinical course without complications was expected. A primary reperfusion strategy was not indicated by the current guidelines. Under established anticoagulation, the patient was found in cardiac arrest immediately after mobilisation from the bed the next morning. Right heart catheterisation under ongoing resuscitation revealed a complete obstruction of the right pulmonary artery by a big thrombus...
June 13, 2018: BMJ Case Reports
Donggyu Moon, Su Nam Lee, Ki-Dong Yoo, Min Seop Jo
BACKGROUND: Current guidelines for massive pulmonary embolism (PE) treatment recommend primary reperfusion therapy and the option of extracorporeal membrane oxygenation (ECMO). However, these recommendations might not be optimal for patients with poor prognoses who are in cardiogenic shock (CS) or require cardiopulmonary resuscitation (CPR). OBJECTIVE: Evaluate the impact of ECMO support on the clinical outcome of patients with massive PE complicated by CPR or CS...
May 2018: Annals of Saudi Medicine
Rolf P Engelberger, Nils Kucher
Due to the manifold treatment options for the management of acute pulmonary embolism, state-of-the-art management requires risk stratification for choosing the adapted treatment for each patient. Reperfusion therapy is an integral part of therapy for patients with pulmonary embolism at high risk for mortality, but its role in patients with intermediate risk pulmonary embolism is more debated. The largest amount of evidence exists for systemic thrombolysis, which is an efficient therapy, but at the prize of an increased bleeding risk...
May 2018: Hämostaseologie
Jan Mrozek, Jana Petrova, Jana Vaclavkova, Vladimir Janovsky, Lubos Kraus, Pavel Jansa
BACKGROUND AND AIM: Thromboembolic disease is the third most common cardiovascular disorder and deep vein thrombosis carries the risk of pulmonary embolism (PE). Questions related to reperfusion after PE remain, especially risk factors. Incomplete reperfusion after PE is closely related to the development of chronic thromboembolic pulmonary hypertension. The aim of this study was to determine the relation between reperfusion after PE in the long term over a period of 24 months, laboratory results and clinical risk factors found during the initial PE event...
June 2018: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
Antonio Salsano, Elena Sportelli, Guido Maria Olivieri, Nicola Di Lorenzo, Silvia Borile, Francesco Santini
Patients with submassive pulmonary embolism (PE), although normotensive, are characterized by right ventricular (RV) dysfunction and elevated levels of biomarkers of cardiac damage. The best treatment option in these cases is still a subject of debate and the use of thrombolysis in submassive PE remains controversial. A 57-year-old Caucasian male with unprovoked PE, normal blood pressure, and elevated troponin I values was referred to the cardiovascular department. In view of the presence of a right atrium thrombus, the patient underwent surgical embolectomy under extracorporeal circulation, with the extraction of a huge thrombus together with fragmented thrombi from both pulmonary arteries...
December 2017: Journal of Extra-corporeal Technology
Aileen Kharat, Béatrice Duxbury, Anne-Lise Hachull, Stéphane Noble, Hélène Bouvaist, Paola M Soccal, Frédéric Lador
Chronic thromboembolic pulmonary hypertension (CTEPH) is uncommon. Its diagnosis should not be delayed as its prognosis is poor if not treated. In most cases, an acute pulmonary embolism is found in the medical history of the patient. Once suspected, a specific work-up should be performed in a pulmonary hypertension (PH) center. The ventilation/perfusion scan has a central role in this workup but the emergence of non invasive imaging technologies provides morphological and functional information which take part in the therapeutic decision making, such as operability...
November 15, 2017: Revue Médicale Suisse
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