Trombectomía mecánica en la tromboembolia pulmonar aguda de riesgo intermedio-alto / Aspiration thrombectomy for acute pulmonary embolism with an intermediate-high risk

Introducción y objetivo:El tratamiento de la tromboembolia pulmonar (TEP) aguda con riesgo de mortalidad intermedio-alto a los 30 días, sigue sin estar bien definido, recomendándose por las últimas guías clínicas de la European Society of Cardiology2019 el tratamiento anticoagulante exclusivamente, reduciendo la indicación de trombectomía mecánica a pacientes de riesgo alto o pacientes con riesgo intermedio-alto con mala evolución hemodinámica. Nuestro objetivo fue comprobar la mejoría ecocardiográfica, respiratoria y hemodinámica en las primeras horas de los pacientes sometidos a trombectomía mecánica con tromboembolia pulmonar de riesgo intermedio-alto.Material y métodos:Se analizó la evolución cardíaca por ecocardiografía (diámetro de ventrículo derecho, TAPSE, Onda S e hipertensión pulmonar), hemodinámica, respiratoria y clínica de los pacientes en las primeras 24 horas tras trombectomía mecánica por aspiración, así como las complicaciones hemorrágicas y mortalidad del procedimiento.Resultados:Se llevaron a cabo 42 trombectomías mecánicas, 16 con inestabilidad hemodinámica (TEP masivo) y 26 estables hemodinámicamente (TEP submasivo). Se obtuvo mejoría (p<0,05) en el diámetro de ventrículo derecho, TAPSE, Onda S y presión arterial oxígeno/fracción inspiratoria de oxígeno (PaFi). Ocho pacientes recibieron tratamiento fibrinolítico, presentando 4 de ellos (50%) complicaciones hemorrágicas. Solo un paciente presentó complicación directa por el procedimiento (rotura arteria pulmonar). Ocho pacientes fallecieron en la fase aguda de la enfermedad.Conclusiones:La trombectomía mecánica por aspiración es una técnica segura y efectiva, observando una mejoría de la situación respiratoria, hemodinámica y ecocardiográfica de los pacientes en las primeras 24 horas postprocedimiento con baja tasa de complicaciones frente al tratamiento fibrinolítico. (AU)

Introduction and purpose:The treatment of acute pulmonary embolism (PE) with an intermediate-high risk of mortality at 30 days is still not well defined, recommending the latest clinical guidelines of the European Society of Cardiology 2019 exclusively anticoagulant treatment, reducing the indication for mechanical thrombectomy to high-risk patients or intermediate-high risk patients with poor hemodynamic evolution. Our purpose is to determine the safety and efficacy of aspiration thrombectomy in intermediate-high risk patients with PE and to analyze possible differences in these results between hemodynamically unstable patients (massive PE) and hemodynamically stable patients (submassive PE).Methods:We analyzed all patients who underwent aspiration thrombectomy for PE at our tertiary university hospital during a 34-month period. We compared echocardiographic parameters (right ventricular diameter, tricuspid plane annular plane systolic excursion (TAPSE), S′ wave, and pulmonary hypertension), respiratory parameters (PaO2/FiO2 ratio), and clinical parameters recorded before and 24h after the procedure. We also analyzed bleeding complications and mortality.Results:In the 42 patients included (16 with massive PE and 26 with submassive PE), aspiration thrombectomy resulted in significant improvements in right ventricular diameter, TAPSE, S′ wave, andPaO2/FiO2 ratio. Of the 8 patients administered fibrinolysis, 4 developed bleeding complications. Only one direct complication of the procedure was observed (pulmonary artery rupture). Eight patients died in the acute phase.Conclusions:Aspiration thrombectomy for PE is safe and effective, significantly improving respiratory and hemodynamic parameters in the first 24h after the procedure with a low rate of complications compared to fibrinolysis. (AU)

[Aspiration thrombectomy for acute pulmonary embolism with an intermediate-high risk]. / Trombectomía mecánica en la tromboembolia pulmonar aguda de riesgo intermedio-alto.

INTRODUCTION AND PURPOSE: The treatment of acute pulmonary embolism (PE) with an intermediate-high risk of mortality at 30 days is still not well defined, recommending the latest clinical guidelines of the European Society of Cardiology 2019 exclusively anticoagulant treatment, reducing the indication for mechanical thrombectomy to high-risk patients or intermediate-high risk patients with poor hemodynamic evolution. Our purpose is to determine the safety and efficacy of aspiration thrombectomy in intermediate-high risk patients with PE and to analyze possible differences in these results between hemodynamically unstable patients (massive PE) and hemodynamically stable patients (submassive PE). METHODS: We analyzed all patients who underwent aspiration thrombectomy for PE at our tertiary university hospital during a 34-month period. We compared echocardiographic parameters (right ventricular diameter, tricuspid plane annular plane systolic excursion (TAPSE), S' wave, and pulmonary hypertension), respiratory parameters (PaO2/FiO2 ratio), and clinical parameters recorded before and 24h after the procedure. We also analyzed bleeding complications and mortality. RESULTS: In the 42 patients included (16 with massive PE and 26 with submassive PE), aspiration thrombectomy resulted in significant improvements in right ventricular diameter, TAPSE, S' wave, andPaO2/FiO2 ratio. Of the 8 patients administered fibrinolysis, 4 developed bleeding complications. Only one direct complication of the procedure was observed (pulmonary artery rupture). Eight patients died in the acute phase. CONCLUSIONS: Aspiration thrombectomy for PE is safe and effective, significantly improving respiratory and hemodynamic parameters in the first 24h after the procedure with a low rate of complications compared to fibrinolysis.

Características clínicas, estadificación y tratamiento de los pacientes con carcinoma hepatocelular en la práctica clínica. Estudio prospectivo de una serie de 136 pacientes / Clinical characteristics, staging and treatment of patients with hepatocellular carcinoma in clinical practice. Prospective study of 136 patients

El carcinoma hepatocelular (CHC) es la causa más frecuente de muerte en pacientes cirróticos. No existen en España series prospectivas de un solo centro terciario sobre estos pacientes. Material y método Estudio prospectivo de pacientes diagnosticados de CHC. Se recogieron sus características clínicas y epidemiológicas, metodología diagnóstica, estadificación según el sistema de Barcelona Clinic Liver Cancer (BCLC) y tratamiento. Resultados Se incluyeron 136 pacientes. El 80,9% fueron varones. La edad media fue de 66,62 ± 11,68 años. El 91,2% eran cirróticos. En el 38,97% la etiología de la hepatopatía fue el virus de la hepatitis C (VHC). La sospecha diagnóstica se estableció mediante programa de cribado en un 63,2%. Los criterios no invasivos American Association for the Study of Liver Diseases (AASLD) fueron el principal método diagnóstico (73,5%). Se diagnosticaron en estadio precoz (0-A) el 58,1%, en B el 21,3%, en C el 12,5% y en D el 8,1%. Los pacientes en estadio precoz habían seguido una estrategia de cribado más frecuentemente que aquellos en estadio no precoz (79,75 versus 44,35%, p < 0,001). El 45,58% recibió un tratamiento inicial potencialmente curativo, siendo el más frecuente la inyección percutánea de alcohol (23,13%).ConclusionesLa mayoría de los pacientes con CHC en nuestro centro presentan una cirrosis hepática de base, cuya etiología más frecuente es el VHC. El cribado de los pacientes en riesgo permite diagnosticar un mayor número en estadio precoz, lo que se consigue en más de la mitad de los casos. El tratamiento inicial más empleado fue el percutáneo(AU)

Abstract Hepatocellular carcinoma (HCC) is the most frequent cause of mortality in patients with liver cirrhosis. There are no prospective series from a single tertiary hospital in Spain.Material and Methods We performed a prospective study of patients with HCC in our center. Clinical and epidemiological characteristics, diagnostic method, staging according to the Barcelona Clinic Liver Cancer (BCLC) system and treatment were analyzed.ResultsA total of 136 patients were included (80.9% men). The mean age was 66.62±11.68 years and 91.2% were cirrhotic. Hepatitis C virus (HCV) was the leading cause of liver disease (38.97%). The suspected diagnosis was established by a surveillance program in 63.2%. Noninvasive American Association criteria for the Study of Liver Diseases (AASLD) were the main diagnostic method (73.5%). According to the BCLC, 58.1% were in the early stage (0-A), 21.3% in stage B, 12.5% in stage C and 8.1% in stage D. Early stage patients had followed a surveillance program more frequently than those with non-early stages (79.75% versus 44.35%, p <0.001). Potentially curative initial treatment was used in 45.58%, the most common treatment being percutaneous ethanol injection (23.13%).ConclusionsMost patients with HCC in our hospital have cirrhosis, the most frequent cause being HCV. HCC surveillance in at-risk patients could increase diagnosis of HCC at an early stage. We achieved an early diagnosis in more than half of cases. The most common initial treatment was percutaneous th(AU)

[Clinical characteristics, staging and treatment of patients with hepatocellular carcinoma in clinical practice. Prospective study of 136 patients]. / Características clínicas, estadificación y tratamiento de los pacientes con carcinoma hepatocelular en la práctica clínica. Estudio prospectivo de una serie de 136 pacientes.

UNLABELLED: Hepatocellular carcinoma (HCC) is the most frequent cause of mortality in patients with liver cirrhosis. There are no prospective series from a single tertiary hospital in Spain. MATERIAL AND METHODS: We performed a prospective study of patients with HCC in our center. Clinical and epidemiological characteristics, diagnostic method, staging according to the Barcelona Clinic Liver Cancer (BCLC) system and treatment were analyzed. RESULTS: A total of 136 patients were included (80.9% men). The mean age was 66.62 ± 11.68 years and 91.2% were cirrhotic. Hepatitis C virus (HCV) was the leading cause of liver disease (38.97%). The suspected diagnosis was established by a surveillance program in 63.2%. Noninvasive American Association criteria for the Study of Liver Diseases (AASLD) were the main diagnostic method (73.5%). According to the BCLC, 58.1% were in the early stage (0-A), 21.3% in stage B, 12.5% in stage C and 8.1% in stage D. Early stage patients had followed a surveillance program more frequently than those with non-early stages (79.75% versus 44.35%, p <0.001). Potentially curative initial treatment was used in 45.58%, the most common treatment being percutaneous ethanol injection (23.13%). CONCLUSIONS: Most patients with HCC in our hospital have cirrhosis, the most frequent cause being HCV. HCC surveillance in at-risk patients could increase diagnosis of HCC at an early stage. We achieved an early diagnosis in more than half of cases. The most common initial treatment was percutaneous therapy.