Abstract 19534: Hemodynamic Effects of Ultrasound-Guided Catheter Directed Thrombolysis (UCDT) in Patients With Massive or Sub-Massive Pulmonary Embolism

Background: Pulmonary embolism is the third most common cardiovascular disorder in the US. Multiple treatment options are available and ultrasound assisted catheter directed thrombolysis(UCDT) is promising. We aimed to conduct a meta-analysis of available studies. Methods: A thorough literature search using MeSH key words ‘pulmonary embolism’, ‘ultrasound’ and ‘catheter-directed’ identified 7 studies (240 patients). Of these 197 patients underwent use of Ekosonic UCDT for massive/sub-massive PE. Hemodynamic measures including mean & systolic PA pressure, RV-LV ratio, heart rate & cardiac index were assessed before & after therapy. Meta-analysis was performed using Cochrane Collaboration Review Manager(version 5.1). Effect size was estimated using random effects model & mean difference with 95% CI were calculated. Results: 130 patients were treated with UCDT. Massive PE was diagnosed in 74(30.8%); bilateral PE was reported in 152(63.3%) patients. UCDT was associated with a significant reduction in PA systolic pressure(-15.2 mmHg; 95% CI -21.0 - -9.4) & mean PA pressure (-9.4mmHg, 95% CI -13.0 - -5.7), in addition to a 24% improvement in cardiac index. The RV size, assessed by the ratio of RV to LV dimensions decreased with UCDT (-0.35; 95% CI -0.42 - -0.28), & heart rate showed similar reduction (-16.9 beats/min; 95% CI -26.5 - -7.3 beats/min). The Miller pulmonary artery occlusion score was available in 87 patients & UCDT resulted in a significant reduction of 10.12 points in Miller score (95% CI -12.21 - -8.02). Short term(30-day) mortality in this group was 3.1%(6/197) while at 90-days cumulative all-cause mortality was 4.6%(7/152). Recurrent events were reported in 2/115 patients(1.7%). Any bleeding complication was reported in 28/197 patients (14.2%) of whom major bleeding was seen in 7 patients (3.5%). Conclusion: In this comprehensive meta-analysis evaluating the impact of UCDT in patients with massive & sub-massive PE, UCDT is associated with significant improvements in hemodynamic measures of RV function. The procedure appears to be safe and is associated with low 30 and 90-day mortality compared to RIETE (8.65%) and ICOPER registries (17.4%) respectively.