Pulmonary Embolisms: Baptist Health’s Leading Role in Advancing Treatment of This Life-Threatening Condition

The potentially life-threatening nature of a pulmonary embolism (PE) can’t be overstated. PEs refer to a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. The most common cause is a condition, deep vein thrombosis (DVT), in which a blood clot develops in the deep veins, most commonly in the legs.

Recent advances in treating PEs, or preventing them by dealing with deep vein thrombosis in early stages, has saved lives. But much depends on the severity of PEs and how quickly treatment can be administered, said Ripal Gandhi, M.D., a vascular interventional radiologist at Miami Cardiac & Vascular Institute, part of Baptist Health, who specializes in minimally invasive treatments.

Ripal Gandhi, M.D., a vascular interventional radiologist at Miami Cardiac & Vascular Institute.

The Institute has taken a leading role in research trials involving PEs and evolving treatment therapies. It has also led local and national efforts in establishing Pulmonary Embolism Response Teams, or PERTs, a group of multidisciplinary experts who come together to offer optimal treatment for patients with high-risk forms of PEs. Dr. Gandhi and Ian Del Conde, M.D., a cardiologist, lead the team at the Institute. The purpose is to have a group of experts at the ready to tackle individual cases of a potentially life-threatening PE. In just a few years, the strategy has expanded to include a growing national consortium of PERTs.

“When we’re talking about very significant pulmonary embolisms, the short-term mortality range is somewhere between 12 percent and 50 percent — with the higher mortality in patients diagnosed with what we classify as a ‘massive pulmonary embolism’ in patients who present with decreased blood pressure or hypotension,” explains Dr. Gandhi.

PE Treatment Advances

Progress in treating PEs involves mostly two options: catheter-directed thrombolysis and mechanical thrombectomy. Both therapies are minimally invasive; catheter-directed thrombolysis uses medication to dissolve thrombus whereas thrombectomy involves catheters to mechanically remove clot.

In both procedures, X-ray imaging is used to help guide a specialized catheter to the site of blood clot to treat the blockage. An interventional radiologist will insert a catheter through the skin into a vessel (artery or vein) and maneuver it to the site of the thrombosis, or blockage. The blood clot will then be dissolved by delivering medication directly to the blood clot to break up the clot. During a thrombectomy, a mechanical device at the site is used to suction the clot or break up the clot and subsequently remove it. Both treatments are referred to as endovascular therapeutic options.

“In the past with PEs, when you look at mortality over the last 20 years, things haven’t really changed a lot until recently,” said Dr. Gandhi. “Now we have a lot more options that we can offer these patients. There are several endovascular therapeutic options that we can provide these patients, and we’re at the leading edge of that.

PE Symptoms, If Any

Some cases of pulmonary embolism do not present with symptoms. If it does, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg.

“There are patients who could have a variety of risk factors, but most patients have a blood clot in their leg, or DVT, which subsequently becomes loose and ends up going to their lungs,” explains Dr. Gandhi. “We typically will see patients who present either with shortness of breath or chest pain — although some patients will have atypical symptoms. They may come to the emergency room with these symptoms, or they may present while they’re in the hospital. Maybe they’re post-op. It’s not uncommon to be post-operatively the patient has a blood clot which goes to the lungs.”

Miami Cardiac & Vascular Institute continues to take a leading role in research to help treat and prevent PEs.

Leading Research in Treating PEs

“We’ve been involved in multiple clinical trials,” said Dr. Gandhi. “We have completed at least two clinical trials in the pulmonary embolism space. We’re currently participating in two other clinical trials in the pulmonary embolism space, one of which is a randomized clinical trial looking at patients with immediate high-risk pulmonary embolisms who are randomized to either catheter-directed thrombectomy versus catheter-directed thrombolysis.”  In addition, physicians at the Institute are participating in a clinical trial utilizing suction thrombectomy to treat extensive DVT.

Preventing new blood clots can prevent PE. According to the National Institutes of Health, prevention measures may include:

• Continue to take blood thinners, if prescribed, and keep up with regular checkups to make sure that the dosage of your medicines is working to prevent blood clots — but not causing bleeding.
• Incorporate heart-healthy lifestyle changes, such as healthy dieting, regular exercise, and, if you smoke, quite smoking.
• Use compression stockings to prevent deep vein thrombosis (DVT) if you are at risk.
• Move your legs when sitting for long periods of time, such as during long trips.
• Move around as soon as possible after surgery or being confined to a bed.
  
  

“We’re really leading the way here in the field of PEs and DVT,” said Dr Gandhi. “We’re participating in all these clinical trials. We’ve presented our findings for other studies at scientific meetings. This is really an area with a lot of excitement because I think we can really improve upon the high morbidity and mortality that we have seen in the past.”