Intravascular ultrasound shows promise in thrombectomy for pulmonary embolism

These findings indicate that intravascular ultrasound (IVUS)-guided mechanical thrombectomy represents a safe and viable option for patients with pulmonary embolism (PE), providing enhanced visualization of the thrombus for precise intervention while also minimizing contrast exposure, according to a study.

The review included 1 prospective study, 2 case series, and 2 case reports, totaling 39 patients. Most patients were female (53.8%) and presented with symptoms such as dyspnea and chest pain (79.5%). Most patients had intermediate-risk PE (87.2%), while 12.8% had high-risk PE. All patients displayed right-heart strain, and more than half (56.4%) had bilateral PE.

IVUS was employed for mechanical thrombectomy without the use of iodinated contrast in 39.4% of the patients, and over time, the need for contrast decreased gradually. One significant finding was a noteworthy decrease in mean arterial pressure following IVUS-guided thrombectomy, from 35.1 ± 7.2 to 25.2 ± 8.3 mmHg.

There were no reported cases of contrast-induced acute kidney injury, all-cause mortality, major bleeding, or any other adverse events post-procedure. The patients’ symptoms improved significantly, and there was a notable enhancement in right ventricular function during the follow-up period.

Reference

Desai R, Raval M, Adompreh-Fia KS, et al. Role of Intravascular Ultrasound in Pulmonary Embolism Patients Undergoing Mechanical Thrombectomy: A Systematic Review. Tomography. 2023;9(4):1393-1407. doi: 10.3390/tomography9040111. PMID: 37489479.