Comparison of Percutaneous Ultrasound-Accelerated Endovascular Thrombolysis (EKOS) with Pigtail Catheter Directed Thrombolysis for the Treatment of Acute Pulmonary Embolism

To compare the technical and clinical success of ultrasound-accelerated endovascular thrombolysis (EKOS) with pigtail catheter directed thrombolysis (PCDT) for the treatment of acute pulmonary embolism (PE). A retrospective study was performed of consecutive patients treated with catheter-directed thrombolysis (CDT) for acute massive and submassive PE between 1/2010 and 8/2014 at a single center. Patients were divided into 2 groups according to the method of CDT used. In the EKOS group, recombinant tissue plasminogen activator (TPA, Genentech Inc, San Francisco, CA) was administered using the EKOS system (EKOS Corp, Bothell, WA), while in the PCDT group, TPA was delivered simply via AP2 angled pigtail catheters (Cook Medical, Bloomington, IN). Patient demographics, right ventricular strain index, adverse events, and change in pulmonary artery pressure (PAP) and Miller PE severity score1 were compared between the groups. Twelve patients with submassive PE and 1 patient with massive PE (9 males, mean age 57±16.5 years) were enrolled in the EKOS group while 6 patients with submassive PE and 2 patients with massive PE (6 males, mean age 55.3±10.4 years) were enrolled in the PCDT group. Demographics, PE burden and RV/LV ratios (1.5±0.4 vs 1.6±0.3) were not significantly different between the groups (p > .05). No mortalities or major adverse events were recorded. Procedure and fluoroscopy time were significantly longer in the EKOS group vs the PCDT group (p < .004). The EKOS group endured less sessions (2.4±0.5 vs 3±0.5, p = .028), received a lower total dose of TPA (27.2±9.6 vs 44±11.8 mg, p = .004), and had shorter infusion times (26.1±7 vs 43.5±12 hours, p = .001) then the PCDT group. There was no significant difference in the change in PAP and Miller severity index between the two groups. EKOS and PCDT demonstrate comparable effectiveness for CDT in patients with acute PE. Procedure and fluoroscopy time for EKOS catheter placement is longer, but infusion times are shorter and TPA dose is lower.