Life-Saving Therapy for Lung Clots: Reported Study Show Ultrasound Helps Drugs Dissolve Clots Offering Hope to Patients

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A new technique that combines the energy of ultrasound with highly targeted delivery of clot-busting drugs appears to be an effective treatment for patients with acute massive pulmonary embolism (PE), commonly referred to as a blood clot in the lung, was presented today at the 37th Annual VEITHsymposium (Vascular Surgery) in New York by Dr. Peter Lin of Baylor College of Medicine in Texas. The novel treatment is called ultrasound-accelerated catheter-directed thrombolysis (developed by EKOS Corporation, Bothell, Washington). It adds a new dimension to catheter-directed thrombolysis, (CDT) a procedure in which a high concentration of clot busting medication is delivered directly to the clot over an extended period of time through an infusion catheter. In ultrasound-accelerated CDT, the infusion catheter includes an element device that emits ultrasound energy in the therapeutic zone; the ultrasound works to make the clot more porous and more penetrable by the thrombolytic agent, thus lessening both the length of time of the infusion and the volume of thrombolytic drug applied. The ultrasound device is a specialized catheter which delivers ultrasound energy while administering a thrombolytic (clot dissolving) drug, tissue plasminogen activator (tPA). This simultaneous combination of ultrasound energy and drugs accelerates clot dissolution. Since its introduction in 2006, the EKOS ultrasound devices have been used primarily to remove blood clots occurring in the legs.

Dr. Lin lauded “while both CDT and ultrasound-accelerated therapy have remarkable therapeutic effects for this life threatening condition, the EKOS device provides a significant added benefit of clearing most if not all the clot while using less drug.”

A new technique that combines the energy of ultrasound with highly targeted delivery of clot-busting drugs appears to be an effective treatment for patients with acute massive pulmonary embolism (PE), commonly referred to as a blood clot in the lung.

The novel treatment is called ultrasound-accelerated catheter-directed thrombolysis (developed by EKOS Corporation, Bothell, Washington). It adds a new dimension to catheter-directed thrombolysis (CDT), a procedure in which a high concentration of clot busting medication is delivered directly to the clot over an extended period of time through an infusion catheter. In ultrasound-accelerated CDT, the infusion catheter includes an element device that emits ultrasound energy in the therapeutic zone; the ultrasound works to make the clot more porous and more penetrable by the thrombolytic agent, thus lessening both the length of time of the infusion and the volume of thrombolytic drug applied.

Reporting on the results of a study of 46 patients treated for massive PE over a ten-year period, Peter Lin, M.D., professor of surgery at the Baylor College of Medicine told attendees at the VEITHsymposium that ultrasound-accelerated CDT achieved complete thrombolysis in 100 percent of the patients treated compared to 67 percent patients receiving CDT without ultrasound. Both the average dose of thrombolytic agent and the length of time for infusion were lower for patients receiving ultrasound-accelerated CDT. Furthermore, there were no hemorrhagic complications within this group compared to 3 incidents in the CDT group. All patients receiving ultrasound-accelerated CDT were treated with tissue plasminogen activator (tPA) as the thrombolytic agent. tPA was administered in 16 of the 21 patients undergoing CDT, with urokinase as the thrombolytic for the other five.

Dr. Lin lauded “while both CDT and ultrasound-accelerated therapy have remarkable therapeutic effects for this life threatening condition, the EKOS device provides a significant added benefit of clearing most if not all the clot while using less drug.” PE accounts for more than 300,000 deaths every year in the United States, and most of these are the result of acute massive PE and typically occur within one hour of presentation. For patients with hemodynamic instability from massive PE, systemic thrombolysis is considered to be the standard of care.

“In institutions with appropriate clinical expertise,” Dr. Lin said, “ultrasound-accelerated thrombolytic is a beneficial treatment option in patients who have acute massive PE with contraindications to systemic thrombolysis, when time to administer systemic thrombolytic agents is lacking, or when no improvement follows stand intravenous thrombolytic administration.”

About VEITHsymposium: Now in its fourth decade, VEITHsymposium provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features over 400 rapid-fire presentations from world-renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques. To register to attend the VEITHsymposium, please visit http://www.VEITHpress.org or contact Pauline T. Mayer at 631.979.3780.

SIDEBAR:
More than 600,000 people in the United States suffer a pulmonary embolism — the obstruction of an artery in the lung, usually by a blood clot — each year, and at least 10 percent die within an hour after symptoms begin. More than 90 percent of the blood clots that cause these embolisms result from deep vein thrombosis (DVT), a condition in which a blood clot forms in one or more of the deep veins in the body, usually the legs. If a blood clot breaks loose, it can travel to your lungs and cause a pulmonary embolism.

Although DVT is most common in people older than 60, it can occur at any age.

In about half of all cases of deep vein thrombosis, there are no symptoms. Signs to watch out for are leg swelling, leg pain or tenderness, and redness or warmth in the leg. Many times, the first sign of deep vein thrombosis is a pulmonary embolism. Warning signs of a pulmonary embolism:

  •    Sudden, unexplained shortness of breath,
  •    Chest pain or discomfort that gets worse when you take a deep breath or cough,
  •    Fainting or feeling lightheaded or dizzy,
  •    Coughing up blood,
  •    Rapid heartbeat.

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