Comparison of Ultrasound-Accelerated versus Pigtail Catheter-Directed Thrombolysis for the Treatment of Acute Massive and Submassive Pulmonary Embolism

Purpose: To compare the technical and clinical effectiveness of ultrasound -accelerated endovascular thrombolysis (USAT) versus pigtail catheter directed thrombolysis (PCDT) for the treatment of acute pulmonary embolism (PE). Materials and Methods: A single-center retrospective study of patients treated with USAT or PCDT for acute massive or submassive PE between January 2010 and December 2016 was performed by reviewing electronic medical records: Sixty treatments were reviewed (mean patient age, 56.7 y +/- 14.6), including 52 cases of submassive PE (21 treated with USAT, 31 with PCDT) and 8 cases of massive PE (3 treated with USAT, 5 with PCDT). Endpoints included pulmonary artery pressure (PAP), Miller PE severity index, tissue plasminogen activator (TPA) dose, infusion duration, procedural variables, and complications. Results: Demographics, PE severity, and right:left ventricular diameter ratios were similar between groups. USAT and PCDT significantly reduced mean PAP (reductions of 7.4 mm Hg [P=.002] and 8.2 mm Hg [P <.001], respectively) and Miller index scores (reductions of 45.8% [P <.001] and 53% [P <.001], respectively) with similar effectiveness (P=.47 and P=.15, respectively). Procedure (P <.001) and fluoroscopy (P=.001) times were significantly longer in the USAT group. The USAT group underwent fewer sessions (2.2 +/- 0.6 vs 2.4 +/- 0.6; P=.17) with shorter infusion times (23.9 h +/- 8.8 vs 30.4 h +/- 12.6; P=.065) and a lower total dose of TPA (27.1 mg +/- 11.3 vs 30.4 mg +/- 12.6; P=.075) compared with the PCDT group, but the differences were not significant. Complications (P=.07) and 30-day mortality rates (P=.56) were not significantly different between groups. Conclusions: USAT and PCDT demonstrated comparable effectiveness and safety in the treatment of patients with acute PE.