In the United States, 200,000 people die from a pulmonary embolism (PE) each year. Most PEs originate from deep vein thrombosis (DVT). Interventionalists are using many therapies and devices to help reduce the harm caused by DVT.
Pharmacomechanical thrombectomy is one such approach that involves using a combination of a lysing agent and a mechanical action to dissolve and collect the thrombus. Covidien recently entered the pharmacomechanical market with its purchase of Bacchus Vascular, makers of Trellis-8 Peripheral Infusion System, which uses two balloons to separate the thrombus, while the lysing agent and a vibrating wire break up the clot.
It’s a good time to step into this market, as the Millennium Research Group predicted an increased growth in pharmacomechanical devices as interventionalists become more aggressive in treating DVT.
Early experience with these devices indicates that reduced lytic doses are used and procedure and recovery times are shortened. But we’ll have to wait until 2014 when results of the ATTRACT trial will be available. This trial will compare catheter-directed thrombolysis with pharmacomechanical thrombectomy.
Another step in this direction came last year when guidelines were revised to allow for the use of pharmacomechanical thrombolysis as a first-line therapy in conjunction with with anticoagulation drug therapy.
Cook Medical, which has manufactured several generations of inferior vena cava (IVC) filters, recently introduced a new delivery system for IVC filters that cuts down on the steps necessary to deploy the devices. Interventionalists no longer have to exchange wires to get their venograms or measurements. The redesigned system, NavAlign, allows these steps to be completed at once.
Representatives from Covidien and Cook at the recent Transcatheter Cardiovascular Therapies (TCT) meeting in San Francisco said there is an increased interest from cardiologists in treating DVT. Both thrombectomy procedures and IVC implantations are reimbursable and newer-generation devices are more accurate and faster to deploy than older-generation devices.
And finally, a review in the October issue of the American Journal of Roentgenology suggested that image-guided pharmacomechanical and catheter-directed thrombolysis deliver better outcomes than anticoagulation therapy alone. The author, Dr. Suresh Vedantham, from the Mallinckrodt Institute, was particularly concerned that too many patients and referring physicians are not aware of thrombolytic options. He wants there to be better communication among the various specialties to get the word out.
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