Background: Ultrasound-facilitated and catheter-directed low-dose fibrinolysis (EKOS) has shown favorable hemodynamic and safety outcomes in intermediate- to high-risk pulmonary embolism (PE) cases. Objectives: This prospective single-arm monocentric study assessed the effects of using a delivery catheter for fibrinolysis as a novel approach for acute intermediate- to high-risk patients on pulmonary artery hemodynamics PE. Methods: Forty-five patients (41 intermediate–high and 4 high risk) with computer tomography (CT)-confirmed PE underwent EKOS therapy. By protocol, a total of 6 mg of tissue-plasminogen activator (t-PA) was administered over 6 h in the pulmonary artery (unilateral 6 mg or bilateral 12 mg). Unfractionated heparin was provided periprocedurally. The primary safety outcome was death, as well as major and minor bleeding within 48 of procedure initiation and at 90 days. The primary effectiveness outcomes were: 1. to assess the difference in pulmonary artery pressure from baseline to 6 h post-treatment as a primary precise surrogate marker, and 2. to determine the echocardiographic RV/LV ratio from baseline to 48 h and at 90 days post-delivery. Results: Pulmonary artery pressure decreased by 15/6/10 mmHg (p < 0.001). The mean RV/LV ratio decreased from 1.2 ± 0.85 at baseline to 0.85 ± 0.12 at 48 and to 0.76 ± 0.13 at 90 days (p < 0.001). Five patients (11%) died within 90 days of therapy. Conclusions and Highlights: Pulmonary artery hemodynamics were assessed using a delivery catheter for fibrinolysis, which is reproducible for identifying PE at risk of adverse outcomes. The results matched the right heart catheter results in EKOS and Heparin arm of Ultima trial, thereby confirming the validity of this potential diagnostic tool to assess therapy effectiveness and thereby reduce additional procedure-related complications, hospital residency, and economics. These results stress the importance of having an interdisciplinary team involved in the management of PE to evaluate the quality of life of these patients and this protocol shortens ICU admission to 6 h.

Die Menge medizinischen Wissens nimmt stetig zu. In noch größerem Ausmaß steigen jedoch Verfügbarkeit und Komplexität von Gesundheitsdaten aus elektronischen Patientenakten, Bildgebungsdaten oder genetischen Profilen bis hin zu Sensorikdaten einer Smartwatch. Eine Kernaufgabe ärztlichen Handelns besteht in der Synthese und Analyse aller verfügbaren Patientendaten. Diese übersteigen mittlerweile jedoch die Leistungsfähigkeit des menschlichen Gehirns und erfordern daher innovative Ansätze in den Bereichen der Informatik und Computerwissenschaften. „Künstliche Intelligenz“ (KI) kann über eine Kombination von Algorithmen, Daten und Rechenleistung menschenähnliche kognitive Prozesse simulieren. Vor allem maschinelles Lernen (ML) hat erhebliches Potenzial in der kardiovaskulären Medizin. Die Befundinterpretation von EKG oder die Diagnose von Vorhofflimmern durch Smartwatches basieren beispielsweise auf dem Einsatz von ML. Die weitere Entwicklung von künstlicher Intelligenz in der Medizin wird jedoch auch von neuen ethischen, datenschutzrechtlichen oder regulatorischen Herausforderungen begleitet. Ein transformativer Nutzen der künstlichen Intelligenz für die kardiovaskuläre Medizin wird jedoch erst durch das Überwinden der Herausforderungen sein volles Potenzial entfalten können. The amount of medical knowledge is constantly increasing. However, to an even greater extent, the availability and complexity of health data from electronic medical records, imaging data, genetic profiles or data from smartwatch sensors is increasing. A core task of the physician is to synthesize and analyze all available patient data. However, the available data exceeds the capacity of the human brain and, therefore, requires innovative approaches in the fields of informatics and computer science. “Artificial intelligence” (AI) can simulate human-like cognitive processes via a combination of algorithms, data, and computing power. Machine learning (ML) in particular has significant impact in the field of cardiovascular medicine. For example, interpretation of ECG findings or diagnosis of atrial fibrillation by smartwatches is already based on ML techniques. The further development of artificial intelligence in medicine, however, is also accompanied by new ethical, data protection or regulatory challenges. A transformative value of artificial intelligence for cardiovascular medicine will only be able to unfold its full potential by overcoming these challenges. Article published online: 20 November 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background: The use of interventional endovascular therapy for pulmonary embolism (PE) has become increasingly important over the last decade. In contrast to other cardiovascular interventions, these procedures carry a higher risk of access-related bleeding due to the acute clinical setting, elevated body mass index, and the frequent need for high-dose anticoagulation. However, there is still no clear consensus regarding the optimal vascular access site for endovascular PE therapy or the impact of ultrasound (US)-guided puncture on access-related complications. Methods: We treated 89 patients with intermediate- to high-risk PE using the Ekosonic endovascular system (EKOS). Group A (n = 39) underwent femoral venous puncture without US guidance, and Group B (n = 50) underwent US-guided femoral venous puncture. Results: Intraprocedural complications differed significantly between the two groups, with a higher incidence of vascular access complications in the non-US-guided group. Access-site pseudoaneurysms and retroperitoneal bleeding events occurred exclusively in the non-US-guided group (n = 6). Major (n = 3) and moderate (n = 5) bleeding events were also observed only in the non-US-guided group (p < 0.001). However, the total length of stay in the intermediate care unit and in the hospital did not differ between the groups. These findings are consistent with prior reports from other interventional settings that demonstrate fewer bleeding events among patients undergoing US-guided procedures. Conclusion: Widespread adoption of US-guided puncture in interventional PE therapy could reduce access-related complications, increase first-pass success, and reduce the number of puncture attempts, inadvertent arterial punctures, and unsuccessful access-site cannulations, particularly in patients with unfavorable access anatomy, obesity, or anatomical variations. Further education and implementation of US-guided access into training programs could improve the adoption of this technique.