Assessment of effectiveness and safety of thrombolytic therapy to pulmonary emboli by endobronchial ultrasound-guided transbronchial needle injectionCentral MessagePerspective

Yuki Sata, MD, PhD; Masato Aragaki, MD, PhD; Terunaga Inage, MD, PhD; Nicholas Bernards, PhD; Alexander Gregor, MD, PhD; Shinsuke Kitazawa, MD, PhD; Fumi Yokote, MD, PhD; Takamasa Koga, MD, PhD; Hiroyuki Ogawa, MD, PhD; Yoshihisa Hiraishi, MD, PhD; Tsukasa Ishiwata, MD, PhD; Andrew Effat, MS; Kate Kazlovich, MS; Harley Chan, PhD; Ichiro Yoshino, MD, PhD; Kazuhiro Yasufuku, MD, PhD, FRCSC

doi:10.1016/j.xjtc.2023.09.005

JTCVS Techniques (Dec 2023)

Assessment of effectiveness and safety of thrombolytic therapy to pulmonary emboli by endobronchial ultrasound-guided transbronchial needle injectionCentral MessagePerspective

Yuki Sata, MD, PhD,
Masato Aragaki, MD, PhD,
Terunaga Inage, MD, PhD,
Nicholas Bernards, PhD,
Alexander Gregor, MD, PhD,
Shinsuke Kitazawa, MD, PhD,
Fumi Yokote, MD, PhD,
Takamasa Koga, MD, PhD,
Hiroyuki Ogawa, MD, PhD,
Yoshihisa Hiraishi, MD, PhD,
Tsukasa Ishiwata, MD, PhD,
Andrew Effat, MS,
Kate Kazlovich, MS,
Harley Chan, PhD,
Ichiro Yoshino, MD, PhD,
Kazuhiro Yasufuku, MD, PhD, FRCSC

Affiliations

Yuki Sata, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
Masato Aragaki, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Terunaga Inage, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
Nicholas Bernards, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Alexander Gregor, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Shinsuke Kitazawa, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Fumi Yokote, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Takamasa Koga, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Hiroyuki Ogawa, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Yoshihisa Hiraishi, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Tsukasa Ishiwata, MD, PhD: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Andrew Effat, MS: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Kate Kazlovich, MS: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
Harley Chan, PhD: TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada
Ichiro Yoshino, MD, PhD: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
Kazuhiro Yasufuku, MD, PhD, FRCSC: Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; TECHNA Institute for the Advancement of Technology for Health, University Health Network, Toronto, Ontario, Canada; Address for reprints: Kazuhiro Yasufuku, MD, PhD, FRCSC, Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, 200 Elizabeth St, 9N-957, Toronto, Ontario, Canada M5G 2C4.

DOI: https://doi.org/10.1016/j.xjtc.2023.09.005
Journal volume & issue: Vol. 22
pp. 292 – 304

Abstract

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Objective: Endobronchial ultrasound–guided transbronchial needle injection (EBUS-TBNI) may effectively treat acute pulmonary embolisms (PEs). Here, we assessed the effectiveness of clot dissolution and safety of tissue plasminogen activator (t-PA) injection using EBUS-TBNI in a 1-week survival study of a porcine PE model. Methods: Six pigs with bilateral PEs were used: 3 for t-PA injection using EBUS-TBNI (TBNI group) and 3 for systemic administration of t-PA (systemic group). Once bilateral PEs were created, each 25 mg of t-PA injection using EBUS-TBNI for bilateral PEs (a total of 50 mg t-PA) and 100 mg of t-PA systemic administration was performed on day 1. Hemodynamic parameters, blood tests, and contrast-enhanced computed tomography scans were carried out at several time points. On day 7, pigs were humanely killed to evaluate the residual clot volume in the pulmonary arteries. Results: The average of percent change of residual clot volumes was significantly lower in the TBNI group than in the systemic group (%: systemic group 36.6 ± 22.6 vs TBNI group 9.6 ± 6.1, P < .01) on day 3. Considering the elapsed time, the average decrease of clot volume per hour at pre-t-PA to post t-PA was significantly greater in the TBNI group than in the systemic group (mm3/hour: systemic 68.1 ± 68.1 vs TBNI 256.8 ± 148.1, P < .05). No hemorrhage was observed intracranially, intrathoracically, or intraperitoneally on any contrast-enhanced computed tomography images. Conclusions: This study revealed that t-PA injection using EBUS-TBNI is an effective and safe way to dissolve clots.

Published in JTCVS Techniques

ISSN: 2666-2507 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.sciencedirect.com/journal/jtcvs-techniques

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