The diagnosis and management of acute pulmonary embolism (PE)
Although there has been significant development in our ability to prevent, diagnose and treat acute pulmonary embolism, it remains a significant cause of morbidity and mortality.1
This has been the rationale for finding new approaches and options for managing patients at intermediate and high-risk of PE. The field has been rapidly evolving, opening up new treatment options beyond standard anticoagulation.
Indeed, if PE can be diagnosed and the appropriate therapy started, the mortality can be reduced from approximately 30% to less than 5%.2,3
In 2019, the ESC updated their guidelines on the use of catheter-directed treatment as an alternative to rescue thrombolytic therapy for patients who deteriorate haemodynamically, bringing their recommendations from Class IIb to Class IIa.4
The PE roadmap shown here is adapted from the European Society of Cardiology (ESC) Guidelines.4
Acute Pulmonary Embolism Consensus Statement by the ESC and EAPCI
A new clinical development has been shared by the European Society of Cardiology and by the European Association of Percutaneous Cardiocavscular Interventions around the treatment of Pulmonary Embolism.
The consensus data formulated by the associations and authored by PE expert leaders has been designed to describe the currently available catheter directed therapies, complementary to the formal guidelines, to treat acute pulmonary embolism.
The paper reviews the standardization of patient selection, the timing and the technique of the procedures as well as protocols of anticoagulations regimes, considered crucial during the treatment.
The consensus serves as a practical guide for Interventional Cardiologist and Vascular Surgeons and it aims to describe and propose a standardised 12 steps protocol for catheter directed therapies including relevant information around timing, imaging before the intervention and the procedural objectives when treating a high-risk and intermediate-high risk PE patient.
Pruszcyk P, et al., Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions. EuroIntervention 2022;18:e623-e638.
1. Stevenson A, Davis S, Murch N., “Pulmonary embolism in acute medicine: a case-based review incorporating latest guidelines in the COVID-19 era.” Br J Hosp Med (Lond). 2020 Jun 2;81(6):1-12.
2. Banovac, R., et al., “Reporting standards for endovascular treatment of pulmonary embolism.” J Vasc Interv Radiol, 2010; 21: 44-53.
3. Tapson, Victor, et al., “A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Risk Pulmonary Embolism: The OPTALYSE PE Trial.” JACC: Cardiovascular Interventions Jul 2018, 11 (14) 1401-10
4. Konstantinides, S.V., et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J, 2020; 41: 543-603
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