November 19, 2010—At the VEITH Symposium in New York City, Peter Lin, MD, presented results supporting the effectiveness of the Ekos ultrasound-accelerated catheter-directed thrombolysis (CDT) (Ekos Corporation, Bothell, WA) to treat patients with acute massive pulmonary embolism (PE).
This therapy combines the energy of ultrasound with the targeted delivery of a thrombolytic agent. CDT delivers a high concentration of thrombolytics directly to the embolus over an extended period of time through an infusion catheter; however, with ultrasound-accelerated CDT, the infusion catheter includes an element device that emits ultrasound energy in the therapeutic zone. The ultrasound works to make the clot more porous and more penetrable to the thrombolytic agent, thus lessening both the length of time for infusion and the amount of thrombolytic drug applied.
Dr. Lin reported the results of a study of 46 patients who were treated for massive PE during a 10-year period. The data showed that ultrasound-accelerated CDT achieved complete thrombolysis in 100% of the patients treated compared to 67% patients receiving CDT without ultrasound. Both the average dose of thrombolytic agent and the length of time for infusion were lower for patients receiving ultrasound-accelerated CDT. Furthermore, there were no hemorrhagic complications within this group compared to three incidents in the CDT group. All patients receiving ultrasound-accelerated CDT were treated with tissue plasminogen activator as the thrombolytic agent. Tissue plasminogen activator was administered in 16 of the 21 patients undergoing CDT, with urokinase as the thrombolytic for the other five.
“Although both CDT and ultrasound-accelerated therapy have remarkable therapeutic effects for this life-threatening condition, the Ekos device provides a significant added benefit of clearing most if not all the clot while using less drug,” concluded Dr. Lin. “In institutions with appropriate clinical expertise, ultrasound-accelerated thrombolysis is a beneficial treatment option in patients who have acute massive PE with contraindications to systemic thrombolysis when time to administer systemic thrombolytic agents is lacking or when no improvement follows standard intravenous thrombolytic administration.”
TOP 5 ARTICLES FROM 2010
- The Angiosome Concept
A look at how this concept is being used to treat patients with critical limb ischemia.
By Osamu Iida, MD; Masaaki Uematsu, MD, PhD; and Hiroto Terashi, MD, PhD
- Chronic Cerebrospinal Venous Insufficiency
A new paradigm and therapy for multiple sclerosis.
By Salvatore J.A. Sclafani, MD
Commentary by Michael D. Dake, MD,
and Barry T. Katzen, MD
- Before You Place That Filter …
A guide to IVC filter placement and troubleshooting procedural challenges.
By Ulku Cenk Turba, MD; Saher S. Sabri, MD; Wael E.A. Saad, MD; Auh Whan Park, MD; John F. Angle, MD; and Alan H. Matsumoto, MD
- Two Years of Extravascular Closure With the Mynx® Vascular Closure Device
The Baptist Memorial Hospital experience revisited.
By David Wolford, MD, FACC
- A New Approach to Diagnosing and Treating CLI
This classification and intervention scoring system was created to provide precise treatment to the target vessel and optimize outcomes.
By J. A. Mustapha, MD, FACC, FSCAI, and C. M. Heaney, RN, BSN, CCRC, CIP