There is a growing clinical and scientific interest in catheter-directed therapy CDT of acute pulmonary embolism PE. Currently, CDT should be considered for patients with high-risk PE, in whom thrombolysis is contraindicated or has failed. Also, CDT is a treatment option for initially stable patients in whom anticoagulant treatment fails, i.
However, the definition of treatment failure primary reperfusion therapy or anticoagulation alone remains an important area of uncertainty. Moreover, several techniques for CDT are available without evidence supporting one over the other, and variation in practice with regard to periprocedural anticoagulation is considerable. The aim of this position paper is to describe the currently available CDT approaches in PE patients and to standardise patient selection, the timing and technique of the procedure itself as well as anticoagulation regimens during CDT.
This clinical consensus statement serves as a practical guide for CDT, complementary to the formal guidelines. Clinical manifestations of acute pulmonary embolism PE vary, ranging from incidentally diagnosed PE without apparent symptoms to obstructive shock with multisystem organ failure, or even sudden cardiac death 1. According to the European Society of Cardiology ESC guidelines on acute PE, reperfusion therapy, preferably systemic thrombolysis, is recommended as the first-line treatment in haemodynamically unstable patients.
Reperfusion therapy should also be considered when initially normotensive PE subjects progress to a state of haemodynamic deterioration despite adequate anticoagulation 1. However, it has been estimated that more than half of high-risk PE patients do not receive systemic thrombolysis due to a perceived increased risk of bleeding 2 3. In such cases, a surgical embolectomy or catheter-directed therapy CDT should be considered 1.
The increasing use of CDT for the treatment of acute PE over the past decade has been paralleled by a growing scientific and clinical interest in this method, both in Europe and the USA 4 5. The aim of this clinical consensus statement is to describe the currently available CDT approaches in PE patients and to standardise patient selection, the timing and technique of the procedure itself as well as anticoagulation regimens during CDT.
