Efficacy and safety of catheter-directed thrombolysis in the treatment of intermediate-risk pulmonary embolism

doi:10.3877/cma.j.issn.2095-5782.2025.01.006

Abstract

Abstract:

Objective

To investigate the safety and efficacy of catheter-directed thrombolysis（CDT） in the treatment of intermediate-risk acute pulmonary embolism （APE） patients.

Methods

From January 2021 to September 2023， clinical data of 46 intermediate-risk APE patients who received CDT were retrospectively collected.The primary efficacy endpoint was the reduction in the right ventricle/left ventricle（RV/LV） ratio from baseline to 7 days post-procedure.The secondary efficacy endpoint included thrombus burden calculated by the Qanadli index， pulmonary artery systolic pressure， N-terminal pro-brain natriuretic peptide （NT-proBNP）， and cardiac troponin T levels.Safety evaluation included major bleeding and clinically relevant nonmajor bleeding defined by the Bleeding Academic Research Consortium （BARC） criteria.Paired sample t-tests and Wilcoxon signed-rank tests were employed to assess the safety and efficacy of CDT in APE patients by comparing initial and post-treatment indicators.

Results

After 24 hours of CDT treatment， heart rate decreased from 93.5±11.6 to 82.4±6.9 beats/min （P＜0.001）， respiratory rate decreased from 20.6±3.0 to 17.6±11.5 breaths/min （P＜0.001）， and there was a significant decrease in NT-proBNP and troponin T［1224.9 ng/L （297.0， 3652.5） vs 339.9 ng/L （99.1， 1515.0）， P=0.005 and 25.4 ng/L （13.4， 60.7） vs 17.3 ng/L（10.3， 30.7）， P=0.029）］.The RV/LV ratio decreased from 1.5±0.2 to 0.9±0.1 （P＜0.001） after 7 days post-CDT.Simultaneously， the Qanadli index decreased from 49.1%±11.6% to 16.7%±9.3% （P＜0.001）.Significant reductions were observed in pulmonary artery systolic pressure ［（51.0±10.6） mmHg vs （32.1±8.1） mmHg，P＜0.001］.NT-proBNP and troponin T both decreased more significantly （P＜0.001）.During hospitalization， no major bleeding events occurred in any of the patients.Six patients （13.0%） experienced non-major bleeding events.During the subsequent 3-month follow-up， 3 patients （6.5%） experienced recurrent pulmonary embolism， and 10 patients （21.7%） had residual small amounts of thrombus.

Conclusion

The use of CDT in the treatment of intermediate-risk APE patients could rapidly improve right heart function and reduce thrombus burden with an acceptable safety profile.

Key words: Pulmonary Embolism, Catheter-directed thrombolysis, RV/LV ratio

Xinghua Zhang, Haitao Yan, Sheng Liu, Qingquan Zu, Haibin Shi. Efficacy and safety of catheter-directed thrombolysis in the treatment of intermediate-risk pulmonary embolism[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(01): 30-34.

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URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2025.01.006

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Figures/Tables 4

变量	数据
年龄［岁，M（Q₁，Q₃）］	62.0 （49.3， 69.5）
性别［例（%）］
男性	26 （56.5）
女性	20 （43.5）
体质量指数（kg/m²， $\overset{ˉ}{x}$ ±s）	26.5±4.1
症状持续时间［d，M（Q₁，Q₃）］	6.5 （2.3， 10.0）
深静脉血栓栓塞症病史［例（%）］	3 （6.5）
近期卧床［例（%）］	6 （13.0）
恶性肿瘤史［例（%）］	5 （10.9）
慢性心肺疾病［例（%）］	5 （10.9）
危险分层［例（%）］
中高危	30 （65.2）
中低危	16 （34.8）

变量	数据
年龄［岁，M（Q₁，Q₃）］	62.0 （49.3， 69.5）
性别［例（%）］
男性	26 （56.5）
女性	20 （43.5）
体质量指数（kg/m²， $\overset{ˉ}{x}$ ±s）	26.5±4.1
症状持续时间［d，M（Q₁，Q₃）］	6.5 （2.3， 10.0）
深静脉血栓栓塞症病史［例（%）］	3 （6.5）
近期卧床［例（%）］	6 （13.0）
恶性肿瘤史［例（%）］	5 （10.9）
慢性心肺疾病［例（%）］	5 （10.9）
危险分层［例（%）］
中高危	30 （65.2）
中低危	16 （34.8）

时间	例数	HR（次/min， $\overset{ˉ}{x}$ ±s）	RR（次/min， $\overset{ˉ}{x}$ ±s）	NT-proBNP ［ng/L， M（Q₁，Q₃）］	肌钙蛋白T ［ng/L， M（Q₁，Q₃）］
术前	46例	93.5±11.6	20.6±3.0	1224.9 （297.0， 3 652.5）	25.4 （13.4， 60.7）
术后24 h	46例	82.4±6.9	17.6±1.5	339.9 （99.1， 1 515.0）	17.3 （10.3， 30.7）
P值		＜0.001	＜0.001	0.005	0.029

时间	例数	HR（次/min， $\overset{ˉ}{x}$ ±s）	RR（次/min， $\overset{ˉ}{x}$ ±s）	NT-proBNP ［ng/L， M（Q₁，Q₃）］	肌钙蛋白T ［ng/L， M（Q₁，Q₃）］
术前	46例	93.5±11.6	20.6±3.0	1224.9 （297.0， 3 652.5）	25.4 （13.4， 60.7）
术后24 h	46例	82.4±6.9	17.6±1.5	339.9 （99.1， 1 515.0）	17.3 （10.3， 30.7）
P值		＜0.001	＜0.001	0.005	0.029

时间	例数	RV/LV（ $\overset{ˉ}{x}$ ±s）	Qanadli指数（%， $\overset{ˉ}{x}$ ±s）	肺动脉收缩压（mmHg， $\overset{ˉ}{x}$ ±s）	NT-proBNP［ng/L， M（Q₁，Q₃）］	肌钙蛋白T［ng/L， M（Q₁，Q₃）］
术前	46例	1.5±0.2	49.1±11.6	51.0±10.6	1224.9 （297.0， 3 652.5）	25.4 （13.4， 60.7）
术后7 d	46例	0.9±0.1	16.7±9.3	32.1±8.1	154.8 （59.1， 448.5）	12.18 （7.4， 22.0）
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

时间	例数	RV/LV（ $\overset{ˉ}{x}$ ±s）	Qanadli指数（%， $\overset{ˉ}{x}$ ±s）	肺动脉收缩压（mmHg， $\overset{ˉ}{x}$ ±s）	NT-proBNP［ng/L， M（Q₁，Q₃）］	肌钙蛋白T［ng/L， M（Q₁，Q₃）］
术前	46例	1.5±0.2	49.1±11.6	51.0±10.6	1224.9 （297.0， 3 652.5）	25.4 （13.4， 60.7）
术后7 d	46例	0.9±0.1	16.7±9.3	32.1±8.1	154.8 （59.1， 448.5）	12.18 （7.4， 22.0）
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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