This session reviewed state-of-the-art interventional techniques in acute PE, which remain outside the mainstream of interest of interventionists.
O. Hess (Zurich) and J. Sandoval (Mexico City) gave perspectives on mechanical removal of proximal clots in high risk PE. Two recent series of 25 and 18 cases, respectively, were particularly discussed (Margheri M, et al. Am J Cardiol 2008; 101: 252, and Guering Eid-Lidt, et al. Chest 2008; 134: 54). J. Sandoval discussed a further 19 cases treated after the publication of the latter paper, proving the method entered into a local clinical routine as an alternative to surgical embolectomy in patients at high-risk both of death due to PA and of bleeding. Altogether, recent series showed immediate clinical improvement, with overall mortality of 4/62. High bleeding rate was, however, found in 17/62 patients who received “hybrid” treatment combining intervention and local thrombolysis. A. Brady (London) reviewed therapeutic options in PE patients presenting with floating right heart thrombi. While evidence is scarce, thrombolysis is usually selected. Surgery is suggested in case of large clots and significant right heart dysfunction, which remains an important determinant of risk in this population. Snares can be used to catch the clot and bring it down to vena cava with subsequent filter implantation above, but the experience is anecdotal. Retrievable venous filters might encourage the use of this mode of PE prevention, particularly in patients with temporary contraindication to anticoagulation. According to P. Mismetti (St. Etienne), less than 50% of retrievable filters are removed mostly due to the presence of thrombi or lack of follow-up. The PREPIC-2 study will further explore the risks and benefits of this intervention.
The session gave important insights into potentially life-saving management options not covered by the recent ESC Guidelines, due to a lack of conclusive evidence. Moreover, the session was well attended.
Acute pulmonary embolism - a new target for interventional cardiology?
This congress report accompanies a presentation given at the ESC Congress 2009. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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