Dorothy Pei, MD
,
Baylor College of Medicine, Houston, TX
Jing Liu, MD
,
Baylor College of Medicine, Houston, TX
Maidah Yaqoob, MD
,
University of Illinois College of Medicine, Chicago, IL
Salman Bandeali, M.B.B.S.
,
Texas Heart Institute, Houston, TX
Ihab Hamzeh, MD, FACC
,
Baylor College of Medicine, Houston, TX
Salim S Virani, MD
,
Baylor College of Medicine, Houston, TX
Ravi S. Hira, M.D.
,
University of Washington, Seattle, WA
Nasser M Lakkis, M.D., FACC, FSCAI
,
Baylor College of Medicine, Houston, TX
Mahboob Alam, M.D., FSCAI
,
Baylor College of Medicine, Sugarland, TX
Background:
Ultrasound-assisted catheter directed thrombolysis (USAT) has been shown to be a promising alternative treatment to systemic thrombolysis in patients with acute massive or sub-massive pulmonary embolism. We performed a meta-analysis of the available published studies to better evaluate the efficacy and safety of USAT.
Methods:
We conducted an extensive literature search in PUBMED, MEDLINE, and EMBASE databases for clinical studies from January 2008 to December 2018. Twenty-eight studies (n= 2135) met inclusion criteria. Efficacy outcomes of the meta-analysis were Miller Index Score, Qanadli Score, pulmonary artery systolic pressure (PASP), mean pulmonary artery pressure (PAP), ratio of right ventricular to left ventricular diameter (RV/LV), cardiac index, and tricuspid annular plane systolic excursion (TAPSE). Safety outcomes were in-hospital mortality, long-term mortality, major and minor bleeding, and recurrent pulmonary embolism. Meta-analysis was performed using Cochrane Collaboration Review Manager (version 5.1). Effect size was estimated using odds ratio (random effects model) with 95% confidence intervals.
Results:
USAT was associated with significant reductions in PASP and mean PAP after therapy by a mean difference of -16.69 mmHg (95% CI: -19.73 to -13.65) and -12.13 mmHg (95% CI: -14.67 to -9.59) respectively. The RV/LV dimension ratio decreased by -0.35 (95% CI: -0.40 to -0.30) after therapy. The mean Miller Index and Qanadli Scores also improved as evidenced by mean reductions of -10.55 (95% CI: -12.98 to -8.12) and -15.64 (95% CI: -19.08 to -12.20) respectively. Cardiac index and TAPSE improved by 0.68 L/m2 (95% CI: 0.49 to 0.87) and 3.68 mm (95% CI: 2.43 to 4.93), respectively, after therapy. In the absence of a control group to compare with, in-hospital mortality in these patients was 2.9%. Total long-term mortality was 4.0%. Major and minor bleeding complications were seen in 5.3% and 6.0% of patients, respectively. Recurrent events occurred in 0.2% of patients after USAT.
Conclusions:
USAT is effective in improving hemodynamic measures and compared to historical data, reduces bleeding complications for the treatment of acute massive and sub-massive pulmonary thromboembolism.
