Clinical Outcomes in Patients With Acute Pulmonary Embolism Undergoing Ultrasound-Assisted Catheter-Directed Thrombolysis.

Background Ultrasound-assisted catheter-directed thrombolysis (USAT) for acute pulmonary embolism (PE) has garnered specific interest and is commonly employed in intermediate-risk PE to prevent cardiac decompensation and death. However, evidence supporting the effectiveness and safety of USAT in routine clinical practice is limited. We therefore aimed to investigate the safety and effectiveness of USAT in a large patient population with PE. Methods And Results The ERASE PE (Bern Acute Pulmonary Embolism Registry) is a single-center cohort study investigating the safety and effectiveness of PE treatment according to the decision of the local PE response team. The specified primary outcome was in-hospital mortality. Between October 2017 and April 2023, 315 patients (mean age 64.3±14.2 years; 38% female) with intermediate-high (n=257, 82%) and high risk (n=58, 18%) PE were treated with USAT. Patients presented with tachycardia (heart rate 104.3±20.4 bpm), hypoxemia (peripheral oxygen saturation 89.2%±7.5%), elevated mean pulmonary artery pressures (30.7±8.0 mm Hg), and reduced mixed venous saturation (venous oxygen saturation 58.5%±10.2%). Patients received USAT with a cumulative dose of 19.8±6.6mg rt-PA over 14.4±2.2 hours. USAT was effective in reducing right ventricular overload and pulmonary artery pressure in 88% of patients with a mean reduction of right ventricular/left ventricular ratio of 0.37±0.29 and mean pulmonary artery pressure of 8.5±7.7 mm Hg, respectively. The primary end point was observed in 10 patients (3.2%). One patient had an embolic stroke (0.3%), 25 patients (7.9%) exhibited bleeding, including 3 patients with intracranial hemorrhage (1.0%), and 3 patients (1.0%) had recurrent PE. Conclusions Among patients with acute PE, USAT effectively reduces right ventricular overload and mean pulmonary artery pressure with low rates of in-hospital mortality and bleeding. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04355975.