1. Innovation in Catheter-Directed Therapy for Intermediate-High-Risk and High-Risk Pulmonary Embolism.
- Author
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Zuin M, Lang I, Chopard R, Sharp ASP, Byrne RA, Rigatelli G, and Piazza G
- Subjects
- Humans, Treatment Outcome, Risk Factors, Risk Assessment, Diffusion of Innovation, Clinical Decision-Making, Catheterization, Peripheral adverse effects, Catheterization, Peripheral instrumentation, Hemodynamics, Pulmonary Embolism therapy, Pulmonary Embolism diagnostic imaging, Thrombolytic Therapy adverse effects, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Anticoagulants administration & dosage, Anticoagulants adverse effects
- Abstract
Although anticoagulation remains the cornerstone treatment for patients with acute pulmonary embolism (PE), catheter-directed therapy (CDT) has generated great interest as an adjunctive option for those presenting with hemodynamic decompensation or high risk for deterioration and in whom systemic thrombolysis has failed or is contraindicated. However, randomized controlled data supporting the efficacy and safety of CDT in addition to antithrombotic therapy in patients with high-risk and intermediate- to high-risk PE compared with anticoagulation and systemic thrombolysis alone are lacking. This paucity of high-quality data hampers guideline recommendations regarding the optimal therapeutic approach in such patients with PE. The aim of the present paper is to critically appraise the current evidence for CDT in patients with high-risk and intermediate- to high-risk PE and to highlight major areas of innovation in the recent literature. In addition, the authors describe unmet clinical and research needs, potential strategies to resolve these knowledge gaps, and pathways for device selection., Competing Interests: Funding Support and Author Disclosures Dr Piazza has received research grants from Bristol Myers Squibb/Pfizer, Janssen, Alexion, Bayer, Amgen, Boston Scientific, Esperion, and 1R01HL164717-01; and is an adviser to Boston Scientific, Amgen, BCRI, PERC, NAMSA, Bristol Myers Squibb, Janssen, and Regeneron. Dr Sharp is a consultant to Medtronic, Boston Scientific, Philips, Penumbra, and Recor Medical; and has stock options with Althea Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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