As the third most common cardiovascular disease, pulmonary embolism (PE) has an uptrending incidence and mortality, resulting in significant healthcare expenditure. Risk stratification of acute PE guides management. Although anticoagulation remains the cornerstone management, systemic fibrinolysis and targeted therapeutic approaches, catheter-directed thrombolysis and catheter-based embolectomy are available for high-risk patients. Life-threatening bleeding complications associated with systemic fibrinolysis have restricted its widespread implementation. Catheter-based techniques for intermediate high-risk categories were devised to reduce bleeding complications and improve outcomes. Catheter-directed thrombolysis helps minimize bleeding by way of direct drug delivery. Catheter-based embolectomy mechanically retrieves thrombi without using fibrinolytics. This focused review of medical and interventional management of acute PE provides a highlight of ongoing trials expected to add value to current practice.
Keywords: catheter-based embolectomy; catheter-based techniques; catheter-directed thrombolysis; fibrinolytics; interventional management of pulmonary embolism; pulmonary embolism; systemic thrombolysis; thrombolytics.
As the third most common disease affecting the heart and blood circulation, clot(s) in a blood vessel in the lungs lead to an increased likelihood of death. Using medication that prevents the blood from clotting is the cornerstone treatment. Medications that break the clot are also available but life-threatening bleeding can occur. Treatment approaches such as using a flexible tube to break the clot or retrieving it are used in severe disease. These approaches were developed to reduce bleeding and improve outcomes by delivering clot-breaking medication directly at the site of the clot. This is a review of managing clots in the blood vessel in the lungs that also provides a highlight of ongoing studies expected to improve current practice.