UMEM Educational Pearls

Title: Advances in Catheter-Directed Therapy for Acute PE - The PERFECT Registry

Keywords: Pulmonary Embolism (PubMed Search)

Posted: 5/19/2015 by John Greenwood, MD
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Advances in Catheter-Directed Therapy for Acute PE - The PERFECT Registry

Earlier this month, initial results from the multicenter PERFECT registry (Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis) were released. In this study, 101 consecutive patients with massive or submassive PE were prospectively enrolled to receive early catheter-directed therapy.

Inclusion criteria:

Massive or submassive PE
Presented within 14 days of symptoms
Had CT evidence of proximal filling defect (main or lobar pulmonary artery)
Age > 18 years old
Had no contraindications to therapeutic anticoagulation
PE not related to tumor thrombus

Therapy provided:

Submassive PE: Low-dose (0.5 - 1.0 mg/hr of urokinase) infusion directly into clot
Massive PE: catheter-directed mechanical or pharmacomechanical thrombectomy followed by low-dose thrombolytic therapy used for submassive PE patients.

Outcomes: Clinical success (stabilization of hemodynamics, improvement in pulmonary hypertension and/or right heart strain, and survival to discharge) was achieved in 86% of patients with massive PE and 97% of patients with submassive PE. There were no major procedure-related complications or major bleeding events.

Bottom Line: In patients with massive or submassive pulmonary embolism, there is growing evidence that early catheter-directed therapy may become first-line therapy for selected patients.

References

1. Kuo WT, Banerjee A, Kim PS, et al. Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): Initial Results from a Prospective Multicenter Registry. Chest. 2015 (ePub April, 2015)

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