NEW YORK (Reuters Health) – Catheter-directed therapy is an effective treatment for acute massive pulmonary embolism (PE) and the risk of major complications is relatively small, the results of a systematic review and meta-analysis indicate.

The lead author Dr. William T. Kuo, from Stanford University Medical Center, Palo Alto, California, and his co-researchers conclude that “at experienced centers, catheter-directed therapy should be considered as a first-line treatment for patients with massive PE.”

With systemic thrombolysis, the standard medical therapy for massive PE, the risk of major hemorrhage is as high as 20%, which includes a 3% to 5% risk of hemorrhagic stroke, according to the report in the Journal of Vascular and Interventional Radiology for November.

The current findings suggest that catheter-directed therapy carries a much lower risk of major complications—2.4%. Moreover, in all 594 patients included in the 35 studies reviewed, just one procedure-associated intracerebral hemorrhage occurred.

In their review, the researchers searched MEDLINE and EMBASE for relevant studies published from January 1990 through September 2008.

The study focused on patients with acute massive PE who were treated with “modern” catheter-directed therapy, defined as use of low-profile devices (10 F or less), mechanical fragmentation and/or aspiration of emboli including rheolytic thrombectomy, and direct clot injection of thrombolytic agents if a local drug was infused. Clinical success, the main endpoint, required hemodynamic stabilization, resolution of hypoxia, and survival to hospital discharge.

Six of the studies reviewed were prospective and 29 were retrospective. The pooled clinical success rate with catheter-directed therapy was 86.5%, while the risks of major and minor complications were 7.9% and 2.4%.

Of 571 patients with available data, 546 (96%) had not previously received systemic thrombolysis, the report indicates.

“Catheter-directed therapy,” the authors state, “is a viable alternative when there are contraindications to systemic thrombolysis, when there is no time to infuse an intravenous thrombolytic, and when there is no response to standard thrombolysis.”

Reference:
J Vasc Interv Radiol 2009;20:1431-1440.