Ultrasound-assisted thrombolysis shows similar outcomes to standard catheter-directed thrombolysis, but adds to the cost

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Efthymios Avgerinos (Pittsburgh, USA) speaks to Interventional News about the SUNSET sPE trial, the one-year results of which he presented at VIVA 2020 (Vascular International Advances; 6–8 November, virtual), and which compared ultrasound-assisted thrombolysis (USAT) to standard catheter-directed thrombolysis (SCDT) in patients with submassive pulmonary embolism.

The primary endpoint was thrombus reduction and secondary endpoints included RV/LV ratio improvement, intensive care unit (ICU) stay, bleeding, and other serious adverse events. Participants were randomised 1:1 to a USAT catheter (EKOS System) or a SCDT catheter (Unifuse, Cragg-McNamara).

In the context of “cost-conscious health systems”, Avgerinos, who was one of the principal investigators of the trial, explains the importance of studying the financial viability of these two interventions. He outlines the key aims of the trial, whose findings showed that although a USAT catheter is “10 times more expensive” than a SCDT catheter, there was no significant difference in mean thrombus score reduction between the two groups (p=0.76) despite a similar average tPA dose and average lysis time.

In the USAT group (n=39), the mean raw pulmonary thrombus score was reduced from 31±4 at baseline to 22±7 (p<0.001). In the SCDT group (n=41), the score was reduced from 33±4 to 23±7 (p<0.001).

Avgerinos states that thrombolytic techniques are, in general, “safe and effective” and are “here to stay”, before concluding that despite this “we need to learn more and that is what we are doing”.


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