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Abstract：
BACKGROUND: Acute pulmonary embolism (APE) poses a significant risk to patient health, with treatment options varying in efficacy and safety. Ultrasound-facilitated catheter-directed thrombolysis (USCDT) has emerged as a potential alternative to conventional catheter-directed thrombolysis (CDT) for patients with intermediate to high-risk APE. This study aimed to compare the efficacy and safety of USCDT versus conventional CDT in patients with intermediate to high-risk APE.
METHODS: This observational retrospective study was conducted at the Armed Forces Hospital, Al-Hada, Taif, the Kingdom of Saudi Arabia (KSA), on 135 patients diagnosed with APE and treated with either USCDT or CDT (58 underwent CDT, while 77 underwent USCDT). The primary efficacy outcome was the change in the right ventricle to the left ventricle (RV/LV) diameter ratio. Secondary outcomes included changes in pulmonary artery systolic pressure and the Miller angiographic obstruction index score. Safety outcomes focused on major bleeding events.
RESULTS: Both USCDT and CDT significantly reduced RV/LV diameter ratio (from 1.35 ± 0.14 to 1.05 ± 0.17, P < 0.001) and systolic pulmonary artery pressure (SPAP) (from 55 ± 7 mmHg to 38 ± 7 mmHg, P < 0.001) at 48- and 12-hours post-procedure, respectively, with no significant differences between treatments. However, USCDT was associated with a significantly lower rate of major bleeding events compared to CDT (0% vs. 3.4%, P = 0.008). Multivariate logistic regression analysis revealed that USCDT was associated with a 71.9% risk reduction of bleeding (OR = 0.281, 95% CI = 0.126 - 0.627, P = 0.002).
CONCLUSIONS: USCDT is a safe and effective alternative to CDT for the treatment of intermediate to high-risk APE, as it significantly reduces the risk of major bleeding.
METHODS: This observational retrospective study was conducted at the Armed Forces Hospital, Al-Hada, Taif, the Kingdom of Saudi Arabia (KSA), on 135 patients diagnosed with APE and treated with either USCDT or CDT (58 underwent CDT, while 77 underwent USCDT). The primary efficacy outcome was the change in the right ventricle to the left ventricle (RV/LV) diameter ratio. Secondary outcomes included changes in pulmonary artery systolic pressure and the Miller angiographic obstruction index score. Safety outcomes focused on major bleeding events.
RESULTS: Both USCDT and CDT significantly reduced RV/LV diameter ratio (from 1.35 ± 0.14 to 1.05 ± 0.17, P < 0.001) and systolic pulmonary artery pressure (SPAP) (from 55 ± 7 mmHg to 38 ± 7 mmHg, P < 0.001) at 48- and 12-hours post-procedure, respectively, with no significant differences between treatments. However, USCDT was associated with a significantly lower rate of major bleeding events compared to CDT (0% vs. 3.4%, P = 0.008). Multivariate logistic regression analysis revealed that USCDT was associated with a 71.9% risk reduction of bleeding (OR = 0.281, 95% CI = 0.126 - 0.627, P = 0.002).
CONCLUSIONS: USCDT is a safe and effective alternative to CDT for the treatment of intermediate to high-risk APE, as it significantly reduces the risk of major bleeding.
摘要：
背景：急性肺栓塞（APE）对患者健康构成重大风险，治疗方案的疗效和安全性各不相同。超声促进导管溶栓（USCDT）已成为中危至高危APE患者常规导管溶栓（CDT）的潜在替代方法。本研究旨在比较USCDT与常规CDT在中高危APE患者中的疗效和安全性。
方法：这项观察性回顾性研究在武装部队医院进行，Al-Hada,Taif,沙特阿拉伯王国（KSA），在135例诊断为APE并接受USCDT或CDT治疗的患者中（58例接受了CDT，77人接受了USCDT)。主要疗效结果是右心室与左心室（RV/LV）直径比的变化。次要结果包括肺动脉收缩压和Miller血管造影阻塞指数评分的变化。安全性结果集中于主要出血事件。
结果：USCDT和CDT均显着降低了RV/LV直径比（从1.35±0.14降至1.05±0.17，P<0.001）和收缩期肺动脉压（SPAP）（从55±7mmHg降至38±7mmHg，P<0.001）在术后48小时和12小时，分别,治疗之间没有显着差异。然而,与CDT相比，USCDT与大出血事件的发生率显着降低相关（0％vs.3.4%,P=0.008)。多因素logistic回归分析显示，USCDT与出血风险降低71.9%相关（OR=0.281，95%CI=0.126～0.627，P=0.002）。
结论：USCDT是一种安全有效的替代CDT治疗中高危APE的方法，因为它显著降低了大出血的风险。
方法：这项观察性回顾性研究在武装部队医院进行，Al-Hada,Taif,沙特阿拉伯王国（KSA），在135例诊断为APE并接受USCDT或CDT治疗的患者中（58例接受了CDT，77人接受了USCDT)。主要疗效结果是右心室与左心室（RV/LV）直径比的变化。次要结果包括肺动脉收缩压和Miller血管造影阻塞指数评分的变化。安全性结果集中于主要出血事件。
结果：USCDT和CDT均显着降低了RV/LV直径比（从1.35±0.14降至1.05±0.17，P<0.001）和收缩期肺动脉压（SPAP）（从55±7mmHg降至38±7mmHg，P<0.001）在术后48小时和12小时，分别,治疗之间没有显着差异。然而,与CDT相比，USCDT与大出血事件的发生率显着降低相关（0％vs.3.4%,P=0.008)。多因素logistic回归分析显示，USCDT与出血风险降低71.9%相关（OR=0.281，95%CI=0.126～0.627，P=0.002）。
结论：USCDT是一种安全有效的替代CDT治疗中高危APE的方法，因为它显著降低了大出血的风险。
