Summary of case reports and studies where EKOS was used to treat pulmonary embolism.
| Study | Patient characteristics | Parameters of right heart strain | Unique features of the case | Outcomes |
|---|---|---|---|---|
| Stambo and Montague [13] | 63/M | Echo revealed RVH with an RVP of 46 mmHg | IV tPA was administered before EKOS/tPA combination | Complete resolution of clot burden with EKOS/tPA combination |
| Bethea et al. [14] | 76/F | RVP 64/8 mmHg | Patient developed HIT after initially coagulation. Later, as she became dyspneic, CTA was repeated, which showed increased clot size and RV dilation. Then EKOS/tPA was done | Pulmonary artery pressure improved to 38/17 mmHg from 58/19 mmHg |
| Khan and Besis [23] | 74/M | RV/LV ratio 1.5/1 | JAK2 kinase +ve in patient | Patient went from requiring 15 L supplemental O2 to maintaining his sats > 90s on room air |
| Cetingok et al. [15] | 49/M | RV/LV ratio 1.1 | Post COVID hypercoagulability | Pulmonary angiography showed complete resolution of the clot burden 18 h after the procedure |
| Rahman et al. [16] | 41/M | RV/LV ratio 1.5 | Patient had Prader-Willi syndrome | Recovery from all symptoms after EKOS/tPA combination |
| Das Gupta et al. [17] | 52/M | RV/LV ratio 1.8 | Post procedural RV/LV ratio 0.87 and RV function was normal | |
| Das Gupta et al. [17] | 62/F | RV/LV ratio 1.6 | Post procedural RV/LV ratio 0.75 and RV function was normal | |
| Das Gupta et al. [17] | 38/F | RV/LV ratio 1.5 | Post procedural RV/LV ratio 0.91 and RV function was normal | |
| Das Gupta et al. [17] | 47/M | RV/LV ratio 1.5 | Post procedural RV/LV ratio of 1 and RV function was normal | |
| Das Gupta et al. [17] | 54/M | RV/LV ratio 1.4 | Post procedural RV/LV ratio of 1 and RV function was mildly reduced | |
| Tirthani et al. [24] | 71/M | The echo showed RV hypokinesis and a flattened interventricular septum | This case demonstrates EKOS’s failure to resolve the clot burden, leading to the use of systemic thrombolysis as a rescue therapy | The patient’s FiO2 showed modest improvement post EKOS and repeated CTA showed persistent right heart strain with minimal improvement in clot burden |
| Ganatra et al. [25] | 86/F | McConnell’s sign of echo | Intracranial hemorrhage after getting treated with EKOS-directed thrombolysis | Left parietal hemorrhage occurred 10 h later, leading to the cessation of tPA and heparin infusion and ultimately death 2 days later |
| Lochan and Raya [18] | 40/M | Enlarged right ventricle on echo | Pulmonary artery pressure decreased from 96/32 mmHg to 47/27mmHg | |
| James et al. [19] | 69/F | McConnell’s sign on echo | Repeat echo post procedure showed a decrease in RV size and improved function | |
| Lauren Lindsey et al. [20] | 38/M | Severely reduced RV systolic function on echo | Severe coagulopathy and development of hemorrhagic intracranial infarcts and hemothoraxUse of VA and VV ECMO | Repeat TTE showed significant improvement in both LV and RV functions |
| Ozturk and Dumantepe [21] | 81/F | Enlarged right ventricle on Echo | PA pressure decreased from 45 mmHg to 30 mmHg | |
| Shammas et al. [22] | 69/F | RV size 3.6 cm | A repeat CTA indicated a reduction in clot burden in the pulmonary artery. Repeat echo showed RV size of 3.1 cm and PA pressure of 44 mmHg (compared to initial 48 mmHg) |
CTA: computed tomography angiography; ECMO: extracorporeal membrane oxygenation; EKOS: EkoSonic Endovascular System; RV: right ventricular; LV: left ventricular; RV/LV: RV to LV; tPA: tissue plasminogen activator.