Optimization of thrombolytic dose for treatment of pulmonary emboli using endobronchial ultrasound-guided transbronchial needle injection

Aragaki, Masato; Inage, Terunaga; Ishiwata, Tsukasa et al.

The Journal of Thoracic and Cardiovascular Surgery, 2023, 165(5), e210-e221

Permalink : https://hdl.handle.net/2115/88942

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論文情報

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アクセス権
open access
URI
https://hdl.handle.net/2115/88942
タイトル
Optimization of thrombolytic dose for treatment of pulmonary emboli using endobronchial ultrasound-guided transbronchial needle injection
著者
Aragaki, Masato ; Inage, Terunaga ; Ishiwata, Tsukasa ; Gregor, Alexander ; Bernards, Nicholas ; Kato, Tatsuya ; Yasufuku, Kazuhiro
e-Rad_Researcher
30788245
著者名
Aragaki, Masato
著者名
Inage, Terunaga
著者名
Ishiwata, Tsukasa
著者名
Gregor, Alexander
著者名
Bernards, Nicholas
著者名
Kato, Tatsuya
著者名
Yasufuku, Kazuhiro
言語
英語
キーワード
endobronchial ultrasound
preclinical animal model
pulmonary embolism
thrombolysis
transbronchial needle injection
発行日
2023-05
収録物名
The Journal of Thoracic and Cardiovascular Surgery
巻(号)
165(5)
ページ
e210-e221
抄録
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.
資源タイプ
学術雑誌論文
出版タイプ
Version of Record
PISSN
0022-5223
関連情報 (isIdenticalTo)
出版社版DOI
https://doi.org/10.1016/j.jtcvs.2022.08.044