Advanced Management of Intermediate- and High-Risk Pulmonary Embolism JACC Focus Seminar

[摘要] Intermediate-risk (submassive) pulmonary embolism (PE) describes normotensive patients with evidence of right ventricular compromise, whereas high-risk (massive) PE comprises those who have experienced hemodynamic decompensation with hypotension, cardiogenic shock, or cardiac arrest. Together, these 2 syndromes represent the most clinically challenging manifestations of the PE spectrum. Prompt therapeutic anticoagulation remains the cornerstone of therapy for both intermediateand high-risk PE. Patients with intermediate-risk PE who subsequently deteriorate despite anticoagulation and those with high-risk PE require additional advanced therapies, typically focused on pulmonary artery reperfusion. Strategies for reperfusion therapy include systemic fibrinolysis, surgical pulmonary embolectomy, and a growing number of options for catheter-based therapy. Multidisciplinary PE response teams can aid in selection of appropriate management strategies, especially where gaps in evidence exist and guideline recommendations are sparse. Published by Elsevier on behalf of the American College of Cardiology Foundation.

[发布日期] 2020-11-03

[关键词] anticoagulation;catheter-directed therapy;catheter thrombolysis;fibrinolysis;IVC filter;mechanical circulatory support;pulmonary embolism;right ventricular failure;surgical embolectomy;thrombolysis