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Catheter-directed therapy for acute pulmonary embolism in children

  • Jyothsna Akam-Venkata (a1), Thomas J. Forbes (a1), Theodore Schreiber (a2), Amir Kaki (a2), Mahir Elder (a2), Daniel R. Turner (a1) and Daisuke Kobayashi (a1)...



Acute pulmonary embolism is a life-threatening condition and rarely occurs in children. In adults, catheter-directed therapy emerges as a potentially safer and effective therapeutic option. However, there is a paucity of data on the safety and efficacy of catheter-directed therapy for pulmonary embolism in children. We report a single-centred experience of catheter-directed therapy for acute pulmonary embolism in children.


This is a retrospective study of children who had no CHD and underwent catheter-directed therapy at Detroit Medical Center during a 12-year period from 2005 to 2017. Demographic and clinical data associated with pulmonary embolism were collected along with the outcome.


A total of nine patients of median age 16 years with the range from 12 to 20 received catheter-directed therapy for sub-massive (n = 6) and massive pulmonary embolism (n = 3). Among nine patients, one patient received Angiojet thrombectomy and balloon angioplasty, whereas eight patients received catheter-directed thrombolysis using tissue plasminogen activator through infusion catheters (n = 3) or EkoSonic ultrasound-accelerated thrombolysis system (n = 5). In four out of five patients treated with EkoSonic, significant clinical improvement was noticed within 24 hours. Among seven patients who survived, two patients had minor gastrointestinal bleeding with median hospital stay of 8 days with the range from 5 to 24 days, and two patients with massive pulmonary embolism died possibly due to delayed institution of catheter-directed therapy.


Catheter-directed therapy with/without EkoSonic is an emerging alternative therapy for sub-massive and massive pulmonary embolism in children. A timely institution of catheter-directed therapy appeared important to improve the outcome.


Corresponding author

Author for correspondence: D. Kobayashi, MD, Division of Cardiology, Children’s Hospital of Michigan, Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201-2119, USA. Tel: +1-313-745-5481; Fax: +1-313-993-0894; E-mail:


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Cite this article: Akam-Venkata J, Forbes TJ, Schreiber T, Kaki A, Elder M, Turner DR, Kobayashi D. (2019) Catheter-directed therapy for acute pulmonary embolism in children. Cardiology in the Young29: 263–269. doi: 10.1017/S1047951118002135



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1. Biss, TT, Brandao, LR, Kahr, WH, Chan, AK, Williams, S. Clinical features and outcome of pulmonary embolism in children. Br J Haematol 2008; 142: 808818.
2. Stein, PD, Kayali, F, Olson, RE. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr 2004; 145: 563565.
3. Jaber, WA, Fong, PP, Weisz, G, et al. Acute pulmonary embolism: with an emphasis on an interventional approach. J Am Coll Cardiol 2016; 67: 9911002.
4. Kuo, WT, Banerjee, A, Kim, PS, et al. Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry. Chest 2015; 148: 667673.
5. 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: 13821392.
6. Bavare, AC, Naik, SX, Lin, PH, et al. Catheter-directed thrombolysis for severe pulmonary embolism in pediatric patients. Ann Vasc Surg 2014; 28: e17911797.
7. Schoepf, UJ, Kucher, N, Kipfmueller, F, Quiroz, R, Costello, P, Goldhaber, SZ. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation 2004; 110: 32763280.10.1161/01.CIR.0000147612.59751.4C
8. Jaff, MR, McMurtry, MS, Archer, SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123: 17881830.
9. Konstantinides, SV, Torbicki, A, Agnelli, G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 30333069; see also pp. 3069a–3069k.
10. Rajpurkar, M, Warrier, I, Chitlur, M, et al. Pulmonary embolism-experience at a single children’s hospital. Thromb Res 2007; 119: 699703.
11. Wang, CY, Ignjatovic, V, Francis, P, et al. Risk factors and clinical features of acute pulmonary embolism in children from the community. Thromb Res 2016; 138: 8690.10.1016/j.thromres.2015.12.005
12. Marti, C, John, G, Konstantinides, S, et al. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2015; 36: 605614.
13. Vedantham, S, Piazza, G, Sista, AK, Goldenberg, NA. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism. J Thromb Thrombolysis 2016; 41: 6880.
14. Konstantinides, SV, Barco, S, Lankeit, M, Meyer, G. Management of pulmonary embolism: an update. J Am Coll Cardiol 2016; 67: 976990.
15. FDA. Label for ACTIVASE [Supplement 5203, Action Date 02/13/2015]. 2015.
16. Kucher, N, Boekstegers, P, Muller, OJ, et al. Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism. Circulation 2014; 129: 479486.
17. Khan, A, Gowda, S, Parekh, D, Qureshi, AM. Use of ultrasound-accelerated, catheter-directed local thrombolysis for venous and arterial occlusions in a pediatric hospital. J Invasive Cardiol 2018; 30: 387392.
18. Qureshi, AM, Petit, CJ, Crystal, MA, Liou, A, Khan, A, Justino, H. Efficacy and safety of catheter-based rheolytic and aspiration thrombectomy in children. Catheter Cardiovasc Interv 2016; 87: 12731280.


Catheter-directed therapy for acute pulmonary embolism in children

  • Jyothsna Akam-Venkata (a1), Thomas J. Forbes (a1), Theodore Schreiber (a2), Amir Kaki (a2), Mahir Elder (a2), Daniel R. Turner (a1) and Daisuke Kobayashi (a1)...


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