ULTIMA
Ultrasound Accelerated Thrombolysis of Pulmonary Embolism
Patient / Population Intervention / Exposure Comparison Outcome
In 59 patients with intermediate-risk pulmonary embolism and right-ventricular dilatation, ultrasound-assisted catheter-directed thrombolysis reversed the right-ventricular-to-left-ventricular diameter ratio at 24 hours more than unfractionated heparin alone.
N
59
Design
Open-label RCT with core-laboratory echocardiographic endpoint
Endpoint
Change in RV/LV diameter ratio from baseline to 24 hours
Relevance
3
ResultRV/LV ratio fell by 0.30 ± 0.20 vs 0.03 ± 0.16 (p<0.001). At 90 days: 1 death (heparin arm), no major bleeding, no recurrent VTE.
Kucher N, Boekstegers P, et al. Circulation. 2014;129(4):479-486. 10.1161/CIRCULATIONAHA.113.005544
Discussion & critique
Only 59 patients and a surrogate imaging endpoint — powered for the RV/LV ratio, not for death, decompensation or bleeding, so the reassuring safety signal carries little weight. It is the first randomised proof of concept for catheter-directed reperfusion and is why guidelines permit it as rescue therapy rather than routine care.