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Optimization of thrombolytic dose for treatment of pulmonary emboli using endobronchial ultrasound-guided transbronchial needle injection
| Title: | Optimization of thrombolytic dose for treatment of pulmonary emboli using endobronchial ultrasound-guided transbronchial needle injection |
| Authors: | Aragaki, Masato Browse this author →KAKEN DB | | Inage, Terunaga Browse this author | | Ishiwata, Tsukasa Browse this author | | Gregor, Alexander Browse this author | | Bernards, Nicholas Browse this author | | Kato, Tatsuya Browse this author | | Yasufuku, Kazuhiro Browse this author |
| Keywords: | endobronchial ultrasound | | preclinical animal model | | pulmonary embolism | | thrombolysis | | transbronchial needle injection |
| Issue Date: | May-2023 |
| Journal Title: | The Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 165 |
| Issue: | 5 |
| Start Page: | e210 |
| End Page: | e221 |
| Publisher DOI: | 10.1016/j.jtcvs.2022.08.044 |
| Abstract: | Objectiv: Severe pulmonary embolism is often managed with thrombolysis. We sought to determine whether endobronchial ultrasound (EBUS)-guided transbronchial thrombolysis remained effective at lower alteplase doses, with the goal of minimizing potential bleeding risk.
Methods: Yorkshire pigs were anesthetized and ventilated. Preformed autologous blood clots were administered into bilateral pulmonary arteries via EBUS-guided transbronchial injection. After documenting baseline clot sizes, alteplase was injected into the clots using a 25-gauge transbronchial needle and clot dissolution was monitored over 30 minutes. The study was performed in 2 phases. First, alteplase doses of 5 and 12.5 mg were evaluated. These results informed dose selection for the second phase. Results were compared with 25-mg dose data using EBUS from a previous study.
Results: In the first phase, 3 clots were evaluated. Distilled water, 5 mg, and 12.5 mg alteplase were administered. The dissolved clot volume (Vdis) and percentage clot volume loss (Rdis) were −10.9, 111.6, and 160.3 mm3, and −1.6%, 11.0%, and 59.3%, respectively. In the second phase, alteplase doses of 5, 10, and 15 mg were evaluated in 12 clots across 6 pigs. The Vdis were 247.5 mm3 (Rdis, 20.1%), 910.8 mm3 (Rdis, 80.9%), and 798.3 mm3 (Rdis, 76.0%) for 5, 10, and 15 mg alteplase, respectively. Remakably reduced performance was observed with 5 mg alteplase versus 10 mg (Vdis: P < .001, Rdis: P < .001), and 15 mg (Vdis: P = .004; Rdis: P < .001). No complications were observed.
Conclusions: Alteplase doses ≥10 mg were optimal for EBUS-guided transbronchial thrombolysis. This technique might represent an effective alternative therapy for central pulmonary embolism. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/88942 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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