Contemporary Management of Acute Pulmonary Embolism: Evolution of Catheter-based Therapy

Acute pulmonary embolism (PE) affects more than 100 000 people in the United States annually and is the third leading cardiovascu-lar cause of death. The standard management for PE is systemic anticoagulation therapy. However, a subset of patients experience hemodynamic decompensation, despite conservative measures. Traditionally, these patients have been treated with systemic administration of thrombolytic agents or open cardiac surgery, although attempts at endovascular treatment have a long history that dates back to the 1960s. The technology for catheter-based therapy for acute PE is rapidly evolving, with multiple devices approved over the past decade. Currently available devices fall into two broad cat-egories of treatment methods: catheter-directed thrombolysis and percutaneous suction thrombectomy. Catheter-directed thromboly-sis is the infusion of thrombolytic agents directly into the occluded pulmonary arteries to increase local delivery and decrease the total dose. Suction thrombectomy involves the use of small-or large-bore catheters to mechanically aspirate a clot from the pulmonary arteries without the need for a thrombolytic agent. A thorough un-derstanding of the various risk stratification schemes and the available evidence for each device is critical for optimal treatment of this complex entity. Multiple ongoing studies will improve our under-standing of the role of catheter-based therapy for acute PE in the next 5–10 years. A multidisciplinary approach through PE response teams has become the management standard at most institutions.