急性肺栓塞介入治疗技术与器械研发进展

Advances in interventional techniques and device development for acute pulmonary embolism

摘要:

急性肺栓塞（APE）是静脉血栓栓塞症最严重的临床类型之一，具有起病急、进展快及病死率高等特点。对于高危及部分中高危APE患者，再灌注治疗是改善预后的关键措施。传统全身溶栓虽可迅速改善肺动脉灌注和右心负荷，但受出血风险高及禁忌证较多等因素限制。近年来，随着风险分层理念不断完善、肺栓塞反应团队推广、导管介入技术进步及专用器械快速发展，导管介入治疗在APE中的应用受到越来越广泛的关注，并逐步由系统溶栓失败后的补救措施发展为风险分层管理下的重要治疗策略。目前，APE导管介入治疗主要包括经皮导管直接接触性溶栓术、猪尾导管碎栓术、人工血栓抽吸术及经皮导管内机械取栓术等，其中机械取栓技术发展尤为迅速。近年来，Indigo、FlowTriever、AlphaVac等进口系统以及Tendvia等国产器械相继应用于临床，相关研究表明，此类机械取栓装置能够在减少或避免溶栓药物使用的同时快速降低血栓负荷，改善右心功能和血流动力学状态，为高危及中高危APE患者提供新的再灌注治疗选择。本文围绕APE介入治疗的指南推荐、技术革新、专用器械研发与应用现状、特殊临床情境下的应用特点及当前面临的问题进行综述，并对未来发展方向进行展望，以期为临床实践及相关器械研发提供参考。

Abstract:

Acute pulmonary embolism (APE) is one of the most severe forms of venous thromboembolism and is characterized by abrupt onset, rapid progression, and high mortality. Reperfusion therapy is a key strategy for improving outcomes in patients with high-risk and selected intermediate-high-risk APE. Although systemic thrombolysis can rapidly restore pulmonary perfusion and reduce right ventricular overload, its clinical use is limited by a substantial risk of bleeding and multiple contraindications. In recent years, with the refinement of risk stratification strategies, the establishment of pulmonary embolism response teams, advances in catheter-based interventions, and the rapid development of dedicated devices, catheter-directed therapy has attracted increasing attention and has gradually evolved from a rescue treatment into an important risk-stratified therapeutic option. Current interventional approaches for APE mainly include catheter-directed thrombolysis, pigtail catheter thrombus fragmentation, manual aspiration thrombectomy, and percutaneous mechanical thrombectomy, among which mechanical thrombectomy has developed most rapidly. Several imported systems, including Indigo, FlowTriever, and AlphaVac, as well as domestically developed devices such as Tendvia, have been introduced into clinical practice. Available evidence suggests that these techniques can rapidly reduce thrombus burden, improve right ventricular function, and stabilize hemodynamics while minimizing or avoiding the use of thrombolytic agents. This article reviews current guideline recommendations, technological advances, device development and clinical applications of interventional therapy for APE, discusses its use in special clinical scenarios and existing challenges, and highlights future directions for research and clinical practice.