VIDEO: What interventional cardiologists need to perform pulmonary embolism thrombectomy
Terry Bowers, MD, director of vascular medicine at Beaumont Hospital, Royal Oak, Michigan, and national co-chair of the Pulmonary Embolism Research Collaborative (PERC), spoke to us about the skillset needed for pulmonary embolism (PE) thrombectomy procedures.
There is a national trend where cardiology is increasingly being called in to help with PE response teams (PERT) at hospitals. Today, this is the direction many centers are going to more aggressively treat PE patients with cath lab catheter thrombectomy to improve outcomes and reduce mortality. There is a growing movement toward this using interdisciplinary PE care team that involve radiology, cardiology, vascular surgery, interventional radiology, emergency room physicians and pulmonology.
"We are 20 years behind in the acute MI initiative, and I think it will evolve similarly to how we did with acute MI therapies," Bowers said.
Bowers added that cardiology is becoming a key partner on PERT teams because patients usually die of right heart failure.
"The right ventricle is the predominant issue," Bowers explained. "People are not dying because of an inability to oxygenate because the pulmonary arteries are thrombosed, they are dying because of right heart failure. RV failure is is a very daunting, difficult to predict spiral down ways, and when it happens, people can die suddenly in front of you."
Cardiologists may not be used to working in the pulmonary artery vascular bed, but Bowers said the learning curve should be relative short if they have experience with peripheral procedures. He said the most technically challenging part is getting the catheters across the right heart and into the lungs.
"The catheter is about 8 mm, or 24 French, so tracking that through the right heart and into the pulmonary artery takes some skill," Bowers explained. "It is feasible and safe, but you need halves some knowledge base."
Bowers said many centers use ultrasound facilitated thrombolysis, but others have standardized using large-bore clot aspiration catheters.
He was recently in Washington, D.C., for a meeting of PE experts, the U.S. Food and Drug Administration (FDA), vendors and the National Pulmonary Embolism Response Team (PERT) Consortium. The FDA wants formal expert input on new devices developed for acute treatment ion PE. The working group is also looking to design a PE registry and pool data that can be used to eventually create a national set of guidelines and best practices based on large-scale clinical data.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com