(HealthDay News) — Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis appears safe and efficacious for acute massive and submassive pulmonary embolism (PE), according to a study published in the August 24 issue of JACC: Cardiovascular Interventions.

Gregory Piazza, MD, from Brigham and Women’s Hospital in Boston, and colleagues conducted a prospective, single-arm, multicenter trial to examine the safety and efficacy of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis using the EkoSonic Endovascular System. One hundred fifty patients with acute massive or submassive (31 and 119, respectively) PE were included. Tissue-plasminogen activator (24mg) was administered as either 1mg/hour for 24 hours with a unilateral catheter or as 1mg/hour/catheter for 12 hours with bilateral catheters.

The researchers found that from baseline to 48 hours post-procedure, the mean right ventricular/left ventricular diameter ratio decreased (1.55 vs. 1.13; P<0.0001). Post-procedure there were also decreases in mean pulmonary artery systolic pressure and modified Miller Index score (both P<0.0001). In 15 patients, there was one Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO)-defined severe bleed and 16 GUSTO-defined moderate bleeding events. There were no cases of intracranial hemorrhage.

“Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis decreased right ventricular dilation, reduced pulmonary hypertension, decreased anatomic thrombus burden, and minimized intracranial hemorrhage in patients with acute massive and submassive PE,” the authors write.

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Several authors disclosed financial ties to pharmaceutical and medical device companies, including EKOS, which developed and manufactured the EkoSonic Endovascular System.

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