OBJECTIVE: We sought to assess the early success and safety of catheter-directed, ultrasound-assisted (CDUA) thrombolysis for @entity1151 ( @entity1151 ) in @entity1 deemed to be "high risk" for thrombolytic therapy. METHODS: A retrospective evaluation of @entity1 who underwent CDUA pulmonary thrombolysis in our practice during 39 months is reported. There were 91 @entity1 considered, all of whom presented with acute @entity1151 as diagnosed by computed tomography angiography. The ratio of the right ventricle to left ventricle diameter (RVaxial:LVaxial) was noted, as were preprocedure pulmonary artery pressures (PAPs). Demographic data, significant medical history, and procedure details were recorded. Standard thrombolysis protocol was followed (1 mg of tissue plasminogen activator per hour per catheter after an initial 2-mg bolus per catheter). Minitab 17 (Minitab Inc, State College, PA) was used for data analysis. RESULTS: There were 91 @entity1 who had a computed tomography diagnosis of acute @entity1151 and @entity120 (PAP >25 mm Hg). Seventeen @entity1 (19%) were deemed to be at high risk for @entity548 , predicted by recent @entity548 , major surgery within 3 weeks, acute @entity583 , and @entity1167 with cardiopulmonary resuscitation within 1 week. The high-risk @entity1 in our study were noted to have higher RV:LV ratios and lower @entity26 saturations on admission (P  < .05). On computed tomography angiography, the mean pretherapy RVaxial:LVaxial ratio was 1.5     0.4. The mean pretherapy PAP was 56.2     15.2 mm Hg. After 18.5     3.5 hours of thrombolysis, the mean post-therapy PAP was 34.3     10.4 mm Hg, with a pressure drop of 21.9     4.8 mm Hg (39% decrease; P  < .001). In total, seven @entity1 (8%) suffered @entity548 complications that required intervention-four @entity360 , a @entity1410 , and one gross @entity811 . Three of the seven complications occurred in the high-risk group (3/17) and the other four in the general population of @entity1 (4/74; P  = .118). Minor @entity548 complications (n  = 14 [15%]) did not require intervention and included puncture site @entity1410 , ecchymosis, and mild traumatic @entity811 . Considering all @entity548 complications, increasing RVaxial:LVaxial ratio was a predictor of any @entity548 complication, independent of all risk factors (P  = .005). CONCLUSIONS: CDUA thrombolysis for acute @entity1151 effectively reduced mean PAPs. Given the low incidence of major @entity548 complications, even in those deemed to be clinically at high risk for @entity548 , we additionally conclude that this procedure can be performed safely. Although larger studies with longer follow-up are necessary, CDUA pulmonary thrombolysis for the management of acute submassive @entity1151 appears to be effective in decreasing right-sided heart strain and can be performed with an acceptable risk profile.

Catheter-directed, ultrasound-assisted thrombolysis is a safe and effective treatment for XXXX , even in high-risk @entity1 .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity548 :: ('MESH:D006470', 'Disease') :: ['hemorrhage', 'bleeding'] @entity26 :: ('MESH:D010100', 'Chemical') :: ['oxygen'] @entity120 :: ('MESH:D006976', 'Disease') :: ['pulmonary hypertension'] @entity1151 :: ('MESH:D011655', 'Disease') :: ['PE', 'acute pulmonary embolism'] @entity1410 :: ('MESH:D006406', 'Disease') :: ['hematomas', 'rectus sheath hematoma'] @entity1167 :: ('MESH:D006323', 'Disease') :: ['cardiac arrest'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity811 :: ('MESH:D006417', 'Disease') :: ['hematuria'] @entity360 :: ('MESH:D006471', 'Disease') :: ['gastrointestinal bleeds']
@entity1151 :: (MESH:D011655,Disease) :: ['pulmonary embolism']
