Ultrasound-enhanced thrombolysis: EKOS endowave infusion catheter system
History of cervical cancer and chest pain. Evidence of acute DVT on ultrasound of legs. Echocardiogram showed pulmonary embolism in PA. No CTA chest, Patient went for direct catheter directed thrombolysis.
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- Right IJ porta catheter.
- Left PICC line catheter.
- Right PICC approach EKOS catheter.
Patient had a pulmonary embolus and underwent catheter directed thrombolysis.
The EKOS catheters have ultrasound transducers within the wire of the catheter which uses ultrasound waves to accelerate the fibrinolytic process and therefore decrease treatment time and decrease the total dose of thrombolytic agent needed which should translate into decreased morbidity and mortality 1.
A prospective multicenter study with 150 patients with acute massive or submassive pulmonary embolism who underwent ultrasound-facilitated, catheter directed, low-dose fibrinolysis showed decreased right ventricular dilatation, decreased pulmonary hypertension, reduced clot burden, and decreased intracranial hemorrhages in these patients. Efficacy outcomes were measured within 48 hours of initiation of fibrinolytic therapy 4. In the case presented, there was also improved cardiac function after administration of tPA via EKOS catheters within 48 hours. Therefore, this case supports the benefits of using EKOS catheters for the administration of fibrinolytics in pulmonary embolism.
- 1. Owens CA. Ultrasound-Enhanced Thrombolysis: EKOS EndoWave Infusion Catheter System. Semin Intervent Radiol. 2008;25 (1): 37-41. doi:10.1055/s-2008-1052304 - Free text at pubmed - Pubmed citation
- 2. Sag S, Nas OF, Kaderli AA et-al. Catheter-directed ultrasound-accelerated thrombolysis may be life-saving in patients with massive pulmonary embolism after failed systemic thrombolysis. J. Thromb. Thrombolysis. doi:10.1007/s11239-016-1370-3 - Pubmed citation
- 3. Lin PH, Annambhotla S, Bechara CF et-al. Comparison of percutaneous ultrasound-accelerated thrombolysis versus catheter-directed thrombolysis in patients with acute massive pulmonary embolism. Vascular. 2010;17 Suppl 3: S137-47. Pubmed citation
- 4. Piazza G, Hohlfelder B, Jaff MR et-al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. JACC Cardiovasc Interv. 2015;8 (10): 1382-92. doi:10.1016/j.jcin.2015.04.020 - Pubmed citation