Terry Bowers, MD, director of vascular medicine at Beaumont Hospital, Royal Oak, Michigan, and national co-chair of the Pulmonary Embolism Research Collaborative (PERC), spoke to us about the skillset needed for pulmonary embolism (PE) thrombectomy procedures.

There is a national trend where cardiology is increasingly being called in to help with PE response teams (PERT) at hospitals. Today, this is the direction many centers are going to more aggressively treat PE patients with cath lab catheter thrombectomy to improve outcomes and reduce mortality. There is a growing movement toward this using interdisciplinary PE care team that involve radiology, cardiology, vascular surgery, interventional radiology, emergency room physicians  and pulmonology. 

"We are 20 years behind in the acute MI initiative, and I think it will evolve similarly to how we did with acute MI therapies," Bowers said.

Bowers added that cardiology is becoming a key partner on PERT teams because patients usually die of right heart failure.

"The right ventricle is the predominant issue," Bowers explained. "People are not dying because of an inability to oxygenate because the pulmonary arteries are thrombosed, they are dying because of right heart failure. RV failure is is a very daunting, difficult to predict spiral down ways, and when it happens, people can die suddenly in front of you." 

Cardiologists may not be used to working in the pulmonary artery vascular bed, but Bowers said the learning curve should be relative short if they have experience with peripheral procedures. He said the most technically challenging part is getting the catheters across the right heart and into the lungs. 

"The catheter is about 8 mm, or 24 French, so tracking that through the right heart and into the pulmonary artery takes some skill," Bowers explained. "It is feasible and safe, but you need halves some knowledge base."

Bowers said many centers use ultrasound facilitated thrombolysis, but others have standardized using large-bore clot aspiration catheters.

He was recently in Washington, D.C., for a meeting of PE experts, the U.S. Food and Drug Administration (FDA), vendors and the  National Pulmonary Embolism Response Team (PERT) Consortium.  The FDA wants formal expert input on new devices developed for acute treatment ion PE. The working group is also looking to design a PE registry and pool data that can be used to eventually create a national set of guidelines and best practices based on large-scale clinical data. 

The American College of Radiology (ACR) announced this week its government relations staff has been engaging federal agencies in an effort to improve product availability and hasten resolution of the ongoing iodine contrast shortage.

Alan Matsumoto, MD, chair of the department of radiology at the University of Virginia and vice chair of the ACR Board of Chancellors, explains how the ACR and group purchasing organizations are asking the FDA to mitigate the contrast shortage with an emergency use authorization to allow non-FDA cleared iodine contrast agents to be imported.

Randall Thompson, MD, immediate past president of the American Society of Nuclear Cardiology, said the group had issues with the document's elevation of cardiac CT and FFR-CT.