“There has been a steady change in the approach and care of pulmonary embolisms that has been noted over the last five to seven years in the US, but also worldwide, and that seems to be spear-headed by a movement towards the development of pulmonary embolization response teams—so-called ‘PERT’ teams,” Jay Giri (Philadelphia, USA) tells Interventional News at the 2019 Vascular and Interventional Advanced meeting (VIVA; 4–7 November 2019, Las Vegas, USA). This demonstrates a shift towards getting patients hospitalised with acute pulmonary embolisms quickly into the hands of expert physicians, “who can give the best recommendations for their care”. Giri explains why the treatment of pulmonary embolisms is not always clear-cut, and in this interview outlines his recommendations from a review of the current data.
Due to a lack of comparative evidence for the utilisation of various therapies for patients with intermediate or high-risk pulmonary embolisms, Giri and collaborators penned a document reviewing the evidence for the safety and efficacy of devices used in their treatment. They categorised the different treatment options into two groups: catheter-directed thrombolysis devices and catheter-based embolectomy devices.
“Right now, there are competing safety profiles between catheter-directed thrombolysis devices and catheter-based embolectomy devices,” Giri shares of the review’s findings, “with the best available evidence showing that catheter-directed lysis devices carry small, but relevant, risks of major bleeding, including intra-cranial haemorrhage, and a low rate, but a verifiable one, when used in the management of pulmonary embolisms.”
Giri et al performed the first ever meta-analysis of prospective trials of catheter-directed lysis devices to assess the rates of intra-cranial haemorrhage; they report an estimated rate of 0.7%. “A modest risk, but one that we still have to keep in mind,” Giri says. While no signal was observed for major bleeding or intra-cranial haemorrhage with catheter-based embolectomy devices, there was a “small but verifiable” risk of haemodynamic or pulmonary decompensation.
“When we are choosing between these devices, one of the key decisions we have to make is the choice between risk profile: bleeding on one hand, and the risk of decompensation on the other,” he concludes.