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2.
BMC Pulm Med ; 24(1): 265, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38825688

RESUMO

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disorder with substantial morbidity and mortality, also a disease underdiagnosed and undertreated. It is potentially curable by pulmonary endarterectomy (PEA) in patients with surgically accessible thrombi. Balloon pulmonary angioplasty (BPA) and targeted medical therapy are options for patients with distal lesions or persistent/recurrent pulmonary hypertension after PEA. There is an urgent need to increase the awareness of CTEPH. Qualified CTEPH centers are still quite limited. Baseline characteristics, management pattern and clinical outcome of CTEPH in China needs to be reported. METHODS AND DESIGN: The CHinese reAl-world study to iNvestigate the manaGEment pattern and outcomes of chronic thromboembolic pulmonary hypertension (CHANGE) study is designed to provide the multimodality treatment pattern and clinical outcomes of CTEPH in China. Consecutive patients who are ≥ 14 year-old and diagnosed with CTEPH are enrolled. The diagnosis of CTEPH is confirmed in right heart catheterization and imaging examinations. The multimodality therapeutic strategy, which consists of PEA, BPA and targeted medical therapy, is made by a multidisciplinary team. The blood sample and tissue from PEA are stored in the central biobank for further research. The patients receive regular follow-up every 3 or 6 months for at least 3 years. The primary outcomes include all-cause mortality and changes in functional and hemodynamic parameters from baseline. The secondary outcomes include the proportion of patients experiencing lung transplantation, the proportion of patients experiencing heart and lung transplantation, and changes in health-related quality of life. Up to 31 December 2023, the study has enrolled 1500 eligible patients from 18 expert centers. CONCLUSIONS: As a real-world study, the CHANGE study is expected to increase our understanding of CTEPH, and to fill the gap between guidelines and the clinical practice in the diagnosis, assessment and treatment of patients with CTEPH. REGISTRATION NUMBER IN CLINICALTRIALS.GOV: NCT05311072.


Assuntos
Angioplastia com Balão , Endarterectomia , Hipertensão Pulmonar , Embolia Pulmonar , Humanos , Hipertensão Pulmonar/terapia , China , Embolia Pulmonar/complicações , Embolia Pulmonar/terapia , Doença Crônica , Qualidade de Vida , Resultado do Tratamento , Feminino , Terapia Combinada , Masculino , População do Leste Asiático
3.
Zhonghua Yi Xue Za Zhi ; 104(24): 2200-2221, 2024 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-38901977

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group 4 pulmonary hypertension, characterized by pulmonary arterial thrombotic occlusion leading to vascular stenosis or obstruction, progressive elevation of pulmonary vascular resistance and pulmonary arterial pressure, ultimately leading to right heart failure and even death. Recent years have seen rapid progress in the diagnostic and therapeutic in CTEPH field. More and more patients with CTEPH have been accurately diagnosed and assessed in time. Nevertheless, there is still a lot of work to do in the popularization of CTEPH diagnostic and therapeutic technique and the building of CTEPH expert center. To better guide clinical practice in our country, Pulmonary Embolism & Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism & Pulmonary Vascular Disease Working Group of Chinese Association of Chest Physicians, National Cooperation Group on Prevention & Treatment of Pulmonary Embolism & Pulmonary Vascular Disease, National Expert Panel on the Development of a Standardized Framework for Pulmonary Arterial Hypertension, convened multidisciplinary experts for deliberation and Delphi expert consensus to develop the "Guidelines for the Diagnosis and Treatment of Chronic Thromboembolic Pulmonary Hypertension (2024 edition) ". These guidelines systematically evaluate domestic and international evidence-based medical research on CTEPH and propose recommendations tailored to clinical practice in our country. The key areas covered include definitions, epidemiology, pathogenesis, diagnosis and assessment, treatment, and management, with the aim of further standardizing the clinical diagnosis and treatment of CTEPH in our country.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Doença Crônica , China
4.
J Vet Sci ; 25(3): e36, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38834506

RESUMO

IMPORTANCE: The intravenous administration of adipose tissue-derived mesenchymal stem cells (AdMSCs) in veterinary medicine is an attractive treatment option. On the other hand, it can result in severe complications, including pulmonary thromboembolism (PTE). OBJECTIVE: The present study assessed the occurrence of PTE after the intravenous infusion of canine AdMSCs (cAdMSCs) into experimental animals. METHODS: Five-week-old male BALB/c hairless mice were categorized into groups labeled A to G. In the control group (A), fluorescently stained 2 × 106 cAdMSCs were diluted in 200 µL of suspension and injected into the tail vein as a single bolus. The remaining groups included the following: group B with 5 × 106 cells, group C with 3 × 106 cells, group D with 1 × 106 cells, group E with 1 × 106 cells injected twice with a one-day interval, group F with 2 × 106 cells in 100 µL of suspension, and group G with 2 × 106 cells in 300 µL of suspension. RESULTS: Group D achieved a 100% survival rate, while none of the subjects in groups B and C survived (p = 0.002). Blood tests revealed a tendency for the D-dimer levels to increase as the cell dose increased (p = 0.006). The platelet count was higher in the low cell concentration groups and lower in the high cell concentration groups (p = 0.028). A histological examination revealed PTE in most deceased subjects (96.30%). CONCLUSIONS AND RELEVANCE: PTE was verified, and various variables were identified as potential contributing factors, including the cell dose, injection frequency, and suspension volume.


Assuntos
Tecido Adiposo , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Camundongos Endogâmicos BALB C , Embolia Pulmonar , Animais , Transplante de Células-Tronco Mesenquimais/veterinária , Transplante de Células-Tronco Mesenquimais/métodos , Cães , Masculino , Camundongos , Tecido Adiposo/citologia , Células-Tronco Mesenquimais/fisiologia , Embolia Pulmonar/veterinária , Embolia Pulmonar/terapia
5.
Front Immunol ; 15: 1402250, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38855107

RESUMO

Background: This study aimed to employ plasma proteomics to investigate the molecular changes, pathway alterations, and potential novel biochemical markers associated with balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Pre- and post-BPA plasma samples from five CTEPH patients in the PRACTICE study were analyzed to identify differentially expressed proteins. Proteomic and bioinformatics analyses were conducted, and the identified proteins were further validated using ELISA assays in a separate cohort of the same study. Correlation and multivariate regression analyses were performed to investigate the associations between these differentially expressed proteins and clinical parameters. Results: Significantly higher serum levels of asialoglycoprotein receptor 2 (ASGR2) were detected in 5 CTEPH patients compared to those in healthy individuals but decreased significantly after successful BPA procedures. The decrease in serum levels of ASGR2 after the completion of BPA procedures was further validated in a separate cohort of 48 patients with CTEPH [0.70 (0.51, 1.11) ng/mL vs. 0.38 (0.27, 0.59) ng/mL, P < 0.001]. Significant associations were found between the pre-BPA ASGR2 level and clinical parameters, including neutrophil percentage (R = 0.285, P < 0.05), platelet (PLT) count (R = 0.386, P < 0.05), and high-density lipoprotein cholesterol (HDL-C) before BPA (R = -0.285, P < 0.05). Significant associations were detected between post-BPA serum ASGR2 levels and lymphocyte percentage (LYM%) (R = 0.306, P < 0.05), neutrophil-to-lymphocyte ratio (R = -0.294, P < 0.05), and pulmonary vascular resistance after BPA (R = -0.35, P < 0.05). Multivariate stepwise regression analysis revealed that pre-BPA ASGR2 levels were associated with HDL-C and PLT count (both P < 0.001), while post-BPA ASGR2 levels were associated with LYM% (P < 0.05). Conclusion: Serum levels of ASGR2 may be a biomarker for the effectiveness of BPA treatment in CTEPH patients. The pre-BPA serum level of ASGR2 in CTEPH patients was associated with HDL-C and the PLT count. The post-BPA serum level of ASGR2 was correlated with the LYM%, which may reflect aspects of immune and inflammatory status.


Assuntos
Angioplastia com Balão , Biomarcadores , Hipertensão Pulmonar , Embolia Pulmonar , Humanos , Masculino , Hipertensão Pulmonar/sangue , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Feminino , Biomarcadores/sangue , Pessoa de Meia-Idade , Embolia Pulmonar/sangue , Embolia Pulmonar/terapia , Idoso , Proteômica/métodos , Doença Crônica
6.
Dtsch Med Wochenschr ; 149(12): 679-683, 2024 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-38781990

RESUMO

Several catheter-based systems have been developed for interventional recanalization of pulmonary embolism. These include local ultrasound assisted thrombolysis (EKOS), in-toto-thrombectomy via retriever and aspiration system (FlowTriever) and the Indigo mechanical aspiration system. Safety and efficacy in the removal of thrombus have been demonstrated for all systems. Interventional recanalization strategies for high- and intermediate-high risk pulmonary embolism are potentially more effective in the removal of thrombus and restoration of right heart function than systemic thrombolysis with a lower risk of major bleeding complications. Preliminary data from registries and observational studies are very promising whereas the evidence for systemic thrombolysis treatment in high and intermediate-high risk pulmonary embolism is low. Randomized controlled clinical trials are currently performed comparing catheter based interventional therapies to systemic thrombolysis for the treatment of intermediate-high risk pulmonary embolisms. Primary outcome measurements include mortality, hemodynamic collapse, and major bleedings. Results are expected in 2025. The introduction of interventional therapies for pulmonary embolism was accompanied by an increased awareness of the complexity of pulmonary embolism management. The need for specialized interdisciplinary pulmonary embolism response teams (PERT-teams) and a well-structured approach including a PDCA cycle was recognized.


Assuntos
Embolia Pulmonar , Trombectomia , Terapia Trombolítica , Embolia Pulmonar/terapia , Humanos
7.
Clin Podiatr Med Surg ; 41(3): 607-617, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38789173

RESUMO

Every surgeon may have experienced a tragic event associated with death or debilitation secondary to deep vein thrombosis (DVT) or pulmonary embolism (PE) after foot and ankle trauma and surgery. Nevertheless, the prevention of such a tragic event needs to be carefully evaluated rationally with currently available epidemiologic data. With great postoperative protocols and access to care, most PE events can be prevented. There are modifiable risk factors, such as length/type of immobilization and operative trauma/time that can lower the incidence of DVT/PE. In addition, chemical prophylaxis may be warranted in certain people within the foot and ankle trauma population.


Assuntos
Traumatismos do Tornozelo , Traumatismos do Pé , Tromboembolia Venosa , Humanos , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/cirurgia , Traumatismos do Pé/complicações , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Fatores de Risco , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Embolia Pulmonar/terapia , Anticoagulantes/uso terapêutico , Incidência
9.
Am Heart J ; 272: 109-112, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38705637

RESUMO

Data comparing catheter-based thrombectomy (CBT) and catheter-directed thrombolysis (CDT) in acute pulmonary embolism are lacking. To address this, we performed a meta-analysis of prospective and retrospective studies of CBT and compared it to performance goal rates of mortality and major bleeding from a recently published network meta-analysis. When compared with performance goal for CDT based on historical studies, CBT was noninferior for all-cause mortality (6.0% vs 6.87%; P-valueNI < .001), non-inferior and superior for major bleeding (4.9% vs 11%; P-valueNI < .001 and P < .001 for superiority).


Assuntos
Embolia Pulmonar , Trombectomia , Terapia Trombolítica , Humanos , Embolia Pulmonar/terapia , Trombectomia/métodos , Terapia Trombolítica/métodos , Doença Aguda , Resultado do Tratamento , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico
10.
Zhonghua Jie He He Hu Xi Za Zhi ; 47(5): 464-469, 2024 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-38706070

RESUMO

In situ pulmonary arterial thrombosis (ISPAT) refers to the formation of new blood clots in the pulmonary arterial system in the absence of pre-existing clots in the peripheral venous system. With the emergence and prevalence of COVID-19, ISPAT has become an increasingly important cause of pulmonary arterial thrombosis (PAT) alongside thromboembolism. Several factors such as hypoxia, inflammation, endothelial dysfunction, and hypercoagulable state can lead to ISPAT, which is associated with a number of conditions such as thoracic trauma, partial lung resection, pulmonary infectious disease, pulmonary vasculitis, connective tissue diseases, severe pulmonary hypertension, radiation pneumonitis, and acute chest syndrome in sickle cell disease. It is important to differentiate between pulmonary thromboembolism (PTE) and ISPAT for proper disease management and prognosis. In this review, we summarized the characteristics of ISPAT under different disease conditions, the methods to distinguish ISPAT from PTE, and the best treatment strategies. We hoped that this review could improve clinicians' understanding of this independent disease and provide guidance for the refined treatment of patients with PAT.


Assuntos
COVID-19 , Artéria Pulmonar , Trombose , Humanos , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/terapia , Trombose/diagnóstico , Trombose/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , SARS-CoV-2
11.
Methodist Debakey Cardiovasc J ; 20(3): 57-64, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38765209

RESUMO

Chronic thromboembolic pulmonary hypertension is a rare form of pulmonary hypertension in patients who have evidence of chronic thromboembolic occlusion of the pulmonary vasculature. Historically, surgical pulmonary thromboendarterectomy has been the treatment of choice. However, with up to 40% of patients deemed inoperable, balloon pulmonary angioplasty has emerged as an additional treatment strategy. Balloon pulmonary angioplasty is a complementary strategy alongside surgical pulmonary thromboendarterectomy and offers the opportunity for pulmonary revascularization in patients who have more distal disease, higher comorbidities, or residual obstruction following operative intervention. This review examines the history of balloon pulmonary angioplasty, highlights its effectiveness, discusses important complications and risk reduction strategies, and emphasizes the importance of centers forming a multidisciplinary team of providers to manage the complexity of patients with chronic thromboembolic pulmonary hypertension.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar , Artéria Pulmonar , Embolia Pulmonar , Humanos , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Embolia Pulmonar/cirurgia , Embolia Pulmonar/complicações , Doença Crônica , Resultado do Tratamento , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Fatores de Risco , Pressão Arterial , Endarterectomia/efeitos adversos
12.
Methodist Debakey Cardiovasc J ; 20(3): 19-26, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38765213

RESUMO

Massive pulmonary embolism (MPE) is a serious condition affecting the pulmonary arteries and is difficult to diagnose, triage, and treat. The American College of Chest Physicians (AHA) and the European Society of Cardiology (ESC) have different classification approaches for PE, with the AHA defining three subtypes and the ESC four. Misdiagnosis is common, leading to delayed or inadequate treatment. The incidence of PE-related death rates has been increasing over the years, and mortality rates vary depending on the subtype of PE, with MPE having the highest mortality rate. The current definition of MPE originated from early surgical embolectomy cases and discussions among experts. However, this definition fails to capture patients at the point of maximal benefit because it is based on late findings of MPE. Pulmonary Embolism Response Teams (PERTs) have emerged as a fundamental shift in the management of MPE, with a focus on high-risk and MPE cases and a goal of rapidly connecting patients with appropriate therapies based on up-to-date evidence. This review highlights the challenges in diagnosing and managing MPE and emphasizes the importance of PERTs and risk stratification scores in improving outcomes for patients with PE.


Assuntos
Valor Preditivo dos Testes , Embolia Pulmonar , Embolia Pulmonar/terapia , Embolia Pulmonar/mortalidade , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Humanos , Resultado do Tratamento , Fatores de Risco , Medição de Risco , Tomada de Decisão Clínica , Embolectomia/efeitos adversos , Técnicas de Apoio para a Decisão , Terapia Trombolítica , Equipe de Assistência ao Paciente
13.
Methodist Debakey Cardiovasc J ; 20(3): 13-18, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38765214

RESUMO

With a multitude of options for pulmonary embolism management, we review the most common diagnostic tools available for assessing risk as well as how each broad risk category is typically treated. Right heart dysfunction is the cornerstone for triage of these patients and should be the focus for decision-making, especially in challenging patients. We aim to provide a modern, clinical perspective for PE management in light of the multitude of intervention options.


Assuntos
Tomada de Decisão Clínica , Embolia Pulmonar , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/diagnóstico por imagem , Humanos , Fatores de Risco , Resultado do Tratamento , Medição de Risco , Valor Preditivo dos Testes , Terapia Trombolítica/efeitos adversos , Embolectomia , Procedimentos Endovasculares/efeitos adversos , Anticoagulantes/uso terapêutico , Anticoagulantes/efeitos adversos , Seleção de Pacientes , Trombectomia
14.
Methodist Debakey Cardiovasc J ; 20(3): 36-48, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38765215

RESUMO

Pulmonary embolism is a debilitating and potentially life-threatening disease characterized by high mortality and long-term adverse outcomes. Traditional treatment options are fraught with serious bleeding risks and incomplete thrombus removal, necessitating the development of innovative treatment strategies. While new interventional approaches offer promising potential for improved outcomes with fewer serious complications, their rapid development and need for more comparative clinical evidence makes it challenging for physicians to select the optimal treatment for each patient among the many options. This review summarizes the current published clinical data for both traditional treatments and more recent interventional approaches indicated for pulmonary embolism. While published studies thus far suggest that these newer interventional devices offer safe and effective options, more data is needed to understand their impact relative to the standard of care. The studies in progress that are anticipated to provide needed evidence are reviewed here since they will be critical for helping physicians make informed treatment choices and potentially driving necessary guideline changes.


Assuntos
Fibrinolíticos , Embolia Pulmonar , Trombectomia , Terapia Trombolítica , Humanos , Tomada de Decisão Clínica , Desenho de Equipamento , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/mortalidade , Fatores de Risco , Trombectomia/efeitos adversos , Trombectomia/instrumentação , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento
15.
Methodist Debakey Cardiovasc J ; 20(3): 65-67, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38765217

RESUMO

Anticoagulation has been the standard therapy for treating pulmonary embolism. However, newly developed pharmacological and interventional treatment options have been shown to provide benefit for certain patient populations, depending on how they present. This column highlights the use of massive pulmonary embolism risk stratification in determining the presence of cor pulmonale and offers several key points to remember when caring for patients with a pulmonary embolism.


Assuntos
Anticoagulantes , Tomada de Decisão Clínica , Embolia Pulmonar , Triagem , Humanos , Anticoagulantes/uso terapêutico , Técnicas de Apoio para a Decisão , Seleção de Pacientes , Valor Preditivo dos Testes , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Medição de Risco , Fatores de Risco , Terapia Trombolítica , Resultado do Tratamento , Masculino , Idoso
16.
Artigo em Inglês | MEDLINE | ID: mdl-38765216

RESUMO

Introductory overview for Methodist DeBakey Cardiovascular Journal Issue 20.3 on Pulmonary Embolism, written by the issues' guest editors.


Assuntos
Embolia Pulmonar , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico , Humanos , Fatores de Risco , Resultado do Tratamento
17.
Zhonghua Jie He He Hu Xi Za Zhi ; 47(5): 404-418, 2024 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-38706062

RESUMO

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group IV pulmonary hypertension, characterized by thrombotic occlusion of the pulmonary arteries leading to vascular stenosis or obstruction, progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, and eventual right heart failure. Unlike other types of pulmonary hypertension, the prognosis of CTEPH can be significantly improved by surgery, vascular intervention, and/or targeted drug therapy. Pulmonary endarterectomy (PEA) is the preferred treatment of choice for CTEPH. However, PEA is an invasive procedure with high operative risks, and is currently only performed in a few centers in China. Balloon pulmonary angioplasty (BPA) is an emerging interventional technique for CTEPH, serving as an alternative for patients who are ineligible for PEA or with residual pulmonary hypertension after PEA. BPA is gaining traction in China, but its widespread adoption is limited due to its complexity, operator skills, and equipment requirements, a lack of standard operating procedures and technical guidance, which limit the further improvement and development of BPA in China. To address this, a multidisciplinary panel of experts was convened to develop the Consensus on the Procedure of Balloon Pulmonary Angioplasty for the Chronic Thromboembolic Pulmonary Hypertension, which fomulates guidelines on BPA procedural qualification, perioperative management, procedural planning, technical approach, and complication prevention, with the aim of providing recommendations and clinical guidance for BPA treatment in CTEPH and standardizing its clinical application in this setting. Summary of recommendations: Recommendation 1: It is recommended that physicians who specialize in pulmonary vascular diseases take the lead in formulating the diagnostic and treatment plans for CTEPH, using a multidisciplinary approach.Recommendation 2: Training in BPA technique is critical; novice operators should undergo standardized operative training with at least 50 procedures under the guidance of experienced physicians before embarking on independent BPA procedures.Recommendation 3: BPA requires catheterization labs, angiography systems, standard vascular interventional devices and consumables, drugs, and emergency equipment.Recommendation 4: Patient selection for BPA should consider cardiac and pulmonary function, coagulation status, and comorbid conditions to determine indications and contraindications, thereby optimizing the timing of the procedure and improving safety.Recommendation 5: In experienced centers, patients deemed likely to benefit from early BPA, based on clinical and imaging features of CTEPH and without elevated D-dimer levels, could bypass standard 3-month anticoagulation therapy.Recommendation 6: BPA is a complex interventional treatment that requires thorough pre-operative assessment and preparation.Recommendation 7: The use of perioperative anticoagulants in BPA requires a comprehensive risk assessment of intraoperative bleeding by the operator for individualized decision making.Recommendation 8: A variety of venous access routes are available for BPA; unless contraindicated, the right femoral vein is usually preferred because of its procedural convenience and reduced radiation exposure.Recommendation 9: For the different types of vascular lesion in CTEPH, treatment of ring-like stenoses, web-like lesions, and subtotal occlusions should be prioritized before addressing complete occlusions and tortuous lesions, in order to reduce complications and improve procedural safety.Recommendation 10: A targeted, incremental balloon dilatation strategy based on vascular lesions is recommended for BPA.Recommendation 11: Intravascular pulmonary artery imaging technologies, such as OCT and IVUS can assist in accurate vessel sizing and confirmation of wire placement in the true vascular lumen. Pressure wires can be used to objectively assess the efficacy of dilatation during BPA.Recommendation 12: Endpoints for BPA treatment should be individually assessed, taking into account improvements in clinical symptoms, hemodynamics, exercise tolerance, and quality of life.Recommendation 13: Post-BPA routine monitoring of vital signs is essential; anticoagulation therapy should be initiated promptly post-procedure in the absence of complications. In cases of intraoperative hemoptysis, postoperative anticoagulation regimen adjustments should be adjusted according to the bleeding severity.Recommendation 14: If reperfusion pulmonary edema occurs during or after BPA, ensure adequate oxygenation, diuresis, and consider non-invasive positive-pressure ventilation if necessary, while severe cases may require early mechanical ventilation assistance or ECMO.Recommendation 15: In cases of intraoperative hemoptysis, temporary balloon occlusion to stop bleeding is recommended, along with protamine to neutralize heparin. Persistent bleeding may warrant the use of gelatin sponges, coil embolization, or covered stent implantation.Recommendation 16: For contrast imaging during BPA, non-ionic, low or iso-osmolar contrast agents are recommended, with hydration status determined by the patient's clinical condition, cardiac and renal function, and intraoperative contrast volume used.


Assuntos
Angioplastia com Balão , Hipertensão Pulmonar , Embolia Pulmonar , Humanos , Angioplastia com Balão/métodos , Hipertensão Pulmonar/terapia , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/terapia , Doença Crônica , Artéria Pulmonar/cirurgia , Endarterectomia/métodos , Consenso , China
18.
Int J Cardiol ; 408: 132165, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-38750964

RESUMO

BACKGROUND: Cancer patients are at risk of pulmonary embolism (PE). Catheter-based therapies (CBT) are novel reperfusion options for PE though data in patients with cancer is lacking. STUDY DESIGN AND METHODS: Patients with intermediate- or high-risk PE were identified using the National Readmission Database (NRD) from 2017 to 2020. Primary outcome were in-hospital death and 90-day readmission. Secondary outcomes were in-hospital bleeding, 90-day readmission for venous thromboembolism (VTE)-related or right heart failure-related reasons and bleeding. Propensity scores were estimated using logistic regression and inverse-probability treatment weighting (IPTW) was utilized to compare outcomes between CBT and no CBT as well as CBT versus systemic thrombolysis. RESULTS: A total of 7785 patients were included (2511 with high-risk PE) of whom 1045 (13.4%) were managed with CBT. After IPTW, CBT was associated with lower rates of index hospitalization death (OR 0.89, 95% CI 0.83-0.96) and 90-day readmission (HR 0.75, 95% CI 0.69-0.81) but higher rates of in-hospital bleeding (OR 1.11, 95% CI 1.03-1.20) which was predominantly post-procedural bleeding. CBT was associated with lower risk of major bleeding (20.8% vs 24.8%; OR 0.80, 95% CI 0.68-0.94) compared with systemic thrombolysis. INTERPRETATION: Among patients with cancer with intermediate or high-risk PE, CBT was associated with lower in-hospital death and 90-day readmission. CBT was also associated with decreased risk of index hospitalization major bleeding compared with systemic thrombolysis. Prospective, randomized trials with inclusion of patients with cancer are needed to confirm these findings.


Assuntos
Mortalidade Hospitalar , Neoplasias , Readmissão do Paciente , Embolia Pulmonar , Humanos , Embolia Pulmonar/terapia , Embolia Pulmonar/mortalidade , Embolia Pulmonar/epidemiologia , Masculino , Feminino , Neoplasias/complicações , Neoplasias/terapia , Neoplasias/epidemiologia , Idoso , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Readmissão do Paciente/tendências , Mortalidade Hospitalar/tendências , Resultado do Tratamento , Estudos Retrospectivos , Terapia Trombolítica/métodos , Idoso de 80 Anos ou mais
20.
Ann Vasc Surg ; 105: 287-306, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38588954

RESUMO

BACKGROUND: Massive pulmonary embolism (MPE) carries significant 30-day mortality risk, and a change in societal guidelines has promoted the increasing use of extracorporeal membrane oxygenation (ECMO) in the immediate management of MPE-associated cardiovascular shock. This narrative review examines the current status of ECMO in MPE. METHODS: A literature review was performed from 1982 to 2022 searching for the terms "Pulmonary embolism" and "ECMO," and the search was refined by examining those publications that covered MPE. RESULTS: In the patient with MPE, veno-arterial ECMO is now recommended as a bridge to interventional therapy. It can reliably decrease right ventricular overload, improve RV function, and allow hemodynamic stability and restoration of tissue oxygenation. The use of ECMO in MPE has been associated with lower mortality in registry reviews, but there has been no significant difference in outcomes between patients treated with and without ECMO in meta-analyses. Applying ECMO is also associated with substantial multisystem morbidity due to systemic inflammatory response, bleeding with coagulopathy, hemorrhagic stroke, renal dysfunction, and acute limb ischemia, which must be factored into the outcomes. CONCLUSIONS: The application of ECMO in MPE should be combined with an aggressive interventional pulmonary interventional program and should strictly adhere to the current selection criteria.


Assuntos
Oxigenação por Membrana Extracorpórea , Embolia Pulmonar , Humanos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/mortalidade , Embolia Pulmonar/terapia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/mortalidade , Embolia Pulmonar/diagnóstico por imagem , Resultado do Tratamento , Fatores de Risco , Hemodinâmica , Recuperação de Função Fisiológica , Tomada de Decisão Clínica , Medição de Risco
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