Document Detail

Intravascular ultrasound in patients with acute pulmonary embolism after treatment with intravenous urokinase and high-dose heparin.
MedLine Citation:
PMID:  9038699     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To compare the diagnostic value of intravascular ultrasound (IVUS) with angiography in patients with pulmonary embolism. DESIGN: Open, prospective clinical study. SETTING: Two university hospitals. PATIENTS: Angiography and IVUS were used in 11 patients (5 men) (mean (SD) age 50 (18) years) with acute pulmonary embolism. INTERVENTIONS: At a mean (SD) of 6 (4) hours after thrombolytic therapy with urokinase and full-dose heparin, all patients underwent pulmonary artery angiography. Then 3.5 F mechanical, 20 or 30 MHz IVUS catheters were advanced into the pulmonary circulation. MAIN OUTCOME MEASURES: The pulmonary circulation was studied by both methods to detect the presence of thrombus, and a modified Miller score (assessing perfusion defects only and not velocity of flow) was used to quantify the angiographic images. RESULTS: The modified Miller score was mean (SD) 7.4 (2.3) points. 168 pulmonary artery segments (diameter range 2-14 mm) were studied by angiography and IVUS. On angiography, seven segments showed complete obstruction and 49 partial obstruction; 112 were normal. Two distinct types of thrombus formation were found by IVUS. Type A thrombus only partly adhered to the wall but otherwise was mobile and type B predominantly adhered to the wall. IVUS confirmed all seven angiographically complete obstructions but missed three (6%) of the 49 partial occlusions. Forty (87%) of the remaining 46 segments had type A thrombus and six (13%) type B. IVUS indicated a thrombus in 38 (34%) of the 112 angiographically normal segments; 20 (53%) showed a type A pattern and 18 (47%) a type B pattern (P < 0.001). CONCLUSION: IVUS was more sensitive than angiography in detecting thrombus but the clinical impact of this finding is not clear as yet.
G Görge; S Schuster; J Ge; J Meyer; R Erbel
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  77     ISSN:  1355-6037     ISO Abbreviation:  Heart     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-03-11     Completed Date:  1997-03-11     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  73-7     Citation Subset:  AIM; IM    
Department of Cardiology, University Hospital, Essen, Germany.
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MeSH Terms
Acute Disease
Drug Administration Schedule
Heparin / administration & dosage*,  therapeutic use
Hypertension, Pulmonary / drug therapy
Middle Aged
Prospective Studies
Pulmonary Artery / radiography
Pulmonary Embolism / drug therapy,  radiography,  ultrasonography*
Thrombolytic Therapy*
Ultrasonography, Interventional*
Urokinase-Type Plasminogen Activator / therapeutic use*
Reg. No./Substance:
9005-49-6/Heparin; EC Plasminogen Activator

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