Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

When seconds count: Interventional radiology treatment for pulmonary embolism saves lives

12.11.2009
Catheter-directed therapy should be considered a first-line treatment option for massive blood clots in the lungs, according to study of nearly 600 patients in Journal of Vascular and Interventional Radiology

Catheter-directed therapy or catheter-directed thrombolysis—an interventional radiology treatment that uses targeted image-guided drug delivery with specially designed catheters to dissolve dangerous blood clots in the lungs—saves lives and should be considered a first-line treatment option for massive pulmonary embolism, note researchers in the November 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 William Kuo, M.D., an interventional radiologist who is assistant professor and fellowship director of vascular and interventional radiology in the Department of Radiology at Stanford University Medical Center in Stanford, Calif. "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," he added.

Pulmonary embolism occurs when one or more arteries in the lungs become blocked from blood clots that break free and travel there. These clots most often begin as deep vein thrombosis (DVT) or blood clots within the deep leg veins. When the clots break free, circulate and become trapped in the lungs, they can block the oxygen supply, cause heart failure and result in death. About 600,000 cases of acute pulmonary embolism are diagnosed each year in the United States, and an estimated 300,000 patients die, noted Kuo. "If initiated early, minimally invasive catheter-directed therapy could save many of those lives," added the lead author of the study, "Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism: Systematic Review and Meta-analysis of Modern Techniques."

During the treatment, an interventional radiologist inserts specially designed catheters (thin plastic tubes) through a tiny incision into one's blood vessels and guides the catheters using real-time imaging without traditional open surgery. This allows an interventional radiologist to deliver a clot-busting medicine directly into the clot. The catheters may also be used to mechanically break up clots and suction them away. This treatment offers less pain and less recovery time than traditional open surgery, said Kuo.

Stanford University researchers conducted a meta-analysis of the treatment on 594 patients in 18 countries who were treated between 1990 and 2008. The treatment was lifesaving in 86.5 percent of the cases studied and had only a 2.4 percent chance of major complications. Researchers 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 percent of patients.

Kuo began this study three years ago after he was asked to assist with a 62-year-old woman who had collapsed at home and was rushed to the emergency room with massive blood clots in her lungs. The patient had been given a large-dose intravenous infusion of clot-busing medicine, a treatment called systemic thrombolysis, but that had failed.

While Kuo was initially consulted to place a special filter to prevent more clots from traveling from the legs to the lungs, he knew it would do little to save her. "I could see that she was quickly dying and there was no time to waste. I remember telling the staff, 'We can do more than just insert a filter. We can go after these clots using specially designed catheters,'" said Kuo. After obtaining consent from the family, Kuo made a tiny incision into the patient's neck and inserted a catheter into the vein. He then used X-ray images (fluoroscopy) to guide the catheter, navigating through the heart and finally reaching the blood clots within the lungs. He injected a clot-busting drug directly into the clots and then used the catheter to mechanically break up the clots before suctioning them out. "The results were immediate, and the treatment saved her life," said Kuo. "That experience inspired me to initiate further studies and to raise awareness of this emerging life-saving procedure," he added.

According to Kuo, the study addressed the use of catheter-directed therapy for treating the most severe or life-threatening form of pulmonary embolism known as "massive" pulmonary embolism. Additional studies are needed to see if the treatment should be initiated in those patients with less severe or "sub-massive" pulmonary embolism, he added. To answer these questions and to analyze further treatment outcomes, Kuo's team is initiating the multicenter PERFECT (Pulmonary Embolism Response to Fragmentation, Embolectomy and Catheter Thrombolysis) registry. In the meantime, the Stanford researchers advocate the use of catheter-directed therapy for massive pulmonary embolism "as both an early and alternative treatment option at centers with the appropriate expertise," said Kuo.

More information about the Society of Interventional Radiology, interventional radiologists, pulmonary embolism and the Journal of Vascular and Interventional Radiology can be found online at www.SIRweb.org.

"Catheter-directed Therapy for the Treatment of Massive Pulmonary Embolism: Systematic Review and Meta-analysis of Modern Techniques" is published in the November Journal of Vascular and Interventional Radiology. Co-authors are William T. Kuo, M.D.; John D. Louie, M.D.; Jarrett K. Rosenberg, Ph.D.; Daniel Y. Sze, M.D., Ph.D.; Lawrence V. Hofmann, M.D., all Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University Medical Center, Stanford, Calif., and Michael K. Gould, M.D., M.S., Pulmonary and Critical Care Division, Department of Medicine, Stanford University Medical Center, Stanford, Calif., and Pulmonary and Critical Care Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.

About the Society of Interventional Radiology

Interventional radiologists are physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-ray, MRI and other imaging to advance a catheter in the body, such as in an artery, to treat at the source of the disease internally. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine. Today, interventional oncology is a growing specialty area of interventional radiology. Interventional radiologists can deliver treatments for cancer directly to the tumor without significant side effects or damage to nearby normal tissue.

Many conditions that once required surgery can be treated less invasively by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery.

Maryann Verrillo | EurekAlert!
Further information:
http://www.SIRweb.org

More articles from Health and Medicine:

nachricht Microgel powder fights infection and helps wounds heal
14.11.2018 | Michigan Technological University

nachricht Spread of deadly eye cancer halted in cells and animals
13.11.2018 | Johns Hopkins Medicine

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: A Chip with Blood Vessels

Biochips have been developed at TU Wien (Vienna), on which tissue can be produced and examined. This allows supplying the tissue with different substances in a very controlled way.

Cultivating human cells in the Petri dish is not a big challenge today. Producing artificial tissue, however, permeated by fine blood vessels, is a much more...

Im Focus: A Leap Into Quantum Technology

Faster and secure data communication: This is the goal of a new joint project involving physicists from the University of Würzburg. The German Federal Ministry of Education and Research funds the project with 14.8 million euro.

In our digital world data security and secure communication are becoming more and more important. Quantum communication is a promising approach to achieve...

Im Focus: Research icebreaker Polarstern begins the Antarctic season

What does it look like below the ice shelf of the calved massive iceberg A68?

On Saturday, 10 November 2018, the research icebreaker Polarstern will leave its homeport of Bremerhaven, bound for Cape Town, South Africa.

Im Focus: Penn engineers develop ultrathin, ultralight 'nanocardboard'

When choosing materials to make something, trade-offs need to be made between a host of properties, such as thickness, stiffness and weight. Depending on the application in question, finding just the right balance is the difference between success and failure

Now, a team of Penn Engineers has demonstrated a new material they call "nanocardboard," an ultrathin equivalent of corrugated paper cardboard. A square...

Im Focus: Coping with errors in the quantum age

Physicists at ETH Zurich demonstrate how errors that occur during the manipulation of quantum system can be monitored and corrected on the fly

The field of quantum computation has seen tremendous progress in recent years. Bit by bit, quantum devices start to challenge conventional computers, at least...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

VideoLinks
Industry & Economy
Event News

“3rd Conference on Laser Polishing – LaP 2018” Attracts International Experts and Users

09.11.2018 | Event News

On the brain’s ability to find the right direction

06.11.2018 | Event News

European Space Talks: Weltraumschrott – eine Gefahr für die Gesellschaft?

23.10.2018 | Event News

 
Latest News

Massive impact crater from a kilometer-wide iron meteorite discovered in Greenland

15.11.2018 | Earth Sciences

When electric fields make spins swirl

15.11.2018 | Physics and Astronomy

Discovery of a cool super-Earth

15.11.2018 | Physics and Astronomy

VideoLinks
Science & Research
Overview of more VideoLinks >>>