SEPTEMBER 2024LIFE SCIENCES REVIEW8cute pulmonary embolism (PE) is common, affecting more than 300,000 people in the U.S. each year. The severity of these blood clots in the lungs cannot be understated. They are complicated to diagnose ­ there are many variable clinical presentations-- and, if not treated quickly, can at times be life-threatening.When I first became a practicing interventional radiologist 30+ years ago, treatment for PE was limited to anticoagulation therapy. This is still considered standard-of-care today. More recently, thrombolytic therapy has become common place for life threatening pulmonary emboli but this therapy comes with a host of potential complications. Patients may experience excessive bleeding and use of these thrombolytic agents also require stays in monitored care units or the intensive care unit (ICU). Over the past decade, advancements in technologies have allowed for the development of potentially more efficient clot removal methods for patients with pulmonary emboli that are causing severe symptoms such as shortness of breath, tachycardia (fast heart rate), low blood pressure and other life-threatening symptoms.The following is a brief overview of how the treatment of PE has evolved beyond drug treatment to include advanced technology.Mainstay PE Treatment: Anticoagulation and ThrombolysisAnticoagulation has been the mainstay of PE treatment. These medications decrease the blood's ability to clot, and patients with PE typically take them for 3 to 6 months and sometimes for life. While anticoagulants can be lifesaving because it helps stabilize the patients' symptoms, these agents do not remove or dissolve the clot. Anticoagulants work by preventing clot from continuing to form and then it is up the body's own inherent thrombolytic system to try to dissolve the clot. While this works well with less symptomatic clot, patients with larger clots can experience lasting debilitating symptoms and these symptoms can affect the patient's well-being for the remainder of their life. Another treatment option for PE has been thrombolytic therapy, or thrombolysis, which uses medications to dissolve the blood clots and prevent new clots from forming. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA). Thrombolysis is performed in the hospital setting to dissolve the clots and improve cardiorespiratory hemodynamics. However, careful patient selection for this therapy is critical as it is associated with several potential complications, including bleeding that can be catastrophic. As a result, not everyone can be treated with thrombolytics and patients need to be closely monitored in either a monitored bed or an ICU post-procedure. New Approach-- Removing Clots with Mechanical ThrombectomyGiven the limitations of anticoagulation and thrombolytic therapy, physicians have been searching for years for a safer and more efficient way to manage pulmonary emboli as well as blood clots in arteries and veins. Penumbra Inc. was instrumental in pioneering the mechanical thrombectomy to remove blood clots in the brain for stroke using a continuous aspiration pump and specially designed atraumatic catheters. This technique of removing clot in the brain worked well and revolutionized the way clot was managed in strokes. With this as a background, a number of physicians began to adapt similar techniques to clear blood clots from arteries in the legs. As one of the early pioneers to look at this new form of therapy, I helped the Penumbra team develop catheters for use outside the brain. In a short period of time, INNOVATION IN PULMONARY EMBOLISM TREATMENT James F. BenenatiBy James F. Benenati, M.D., FSIR, Chief Medical Officer, Penumbra, Inc.IN MY OPINIONa
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