Catheter Directed Therapy for Pulmonary Embolism Proves Successful

A new study claims that-catheter-directed thrombolysis (CDT) should be considered a first-line treatment option for massive blood clots in the lungs.

Researchers at Stanford University Medical Center (CA, USA) conducted a systematic review of electronic literature searches (MEDLINE, EMBASE) for studies published from January 1990 through September 2008. Inclusion criteria were applied to select patients with acute massive pulmonary embolism (PE) treated with modern CDT. Paired reviewers assessed study quality and abstracted data; clinical success was defined as stabilization of hemodynamics, resolution of hypoxia, and survival to hospital discharge.

The researchers found that in 594 patients from 35 studies (6 prospective, 29 retrospective) that met the criteria for inclusion, the pooled clinical success rate from CDT was 86.5%. The pooled risks of minor and major procedural complications were 7.9% and 2.4%, respectively. The researchers also found that not only was the treatment effective, but it also appeared much safer than the historical complication rates reported from injecting high-dose clot-busting medicine systemically or directly into the blood stream, where the drug can circulate throughout the body and cause major bleeding in up to 20% of patients. The study was published in the November 2009 issue of the Journal of Vascular and Interventional Radiology.

"Modern catheter-directed therapy for acute pulmonary embolism saves lives, and we need to raise awareness about its safety and effectiveness not only among the general public but also within the medical community. It's a matter of life and death,” said lead author William Kuo, M.D., of the department of radiology at Stanford. "In our study, we conclude that modern catheter-directed therapy is a relatively safe and effective treatment for acute massive pulmonary embolism and should be considered as a first-line treatment option.”

CTD is performed in a hospital radiology suite by an interventional radiologist, who inserts a catheter into a vein in the leg (generally the popliteal vein) and threads it until it reaches the site of the blood clot. The image-guided catheter allows the doctor to watch the entire procedure on an X-ray video monitor. Once the tip of the catheter reaches the clot, a thrombolytic drug is infused into the clot through the catheter. In most cases, the blood clot will completely dissolve within a few days.

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