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Saddle pulmonary embolism in hemodynamically stable patients: To lyse or not to lyse? An issue in no guidelines land

Published:September 07, 2017DOI:https://doi.org/10.1016/j.ejim.2017.09.002
      Previous studies have shown an incidence of saddle pulmonary embolism (SPE) ranging between 6% to 9.1% in non-high-risk patients [
      • Kwak M.K.
      • Kim W.Y.
      • Lee C.W.
      • Seo D.W.
      • Sohn C.H.
      • Ahn S.
      • et al.
      The impact of saddle embolism on the major adverse event rate of patients with non-high-risk pulmonary embolism.
      ,
      • Ryu J.H.
      • Pellikka P.A.
      • Froehling D.A.
      • Peters S.G.
      • Aughenbaugh G.L.
      Saddle pulmonary embolism diagnosed by CT angiography: frequency, clinical features and outcome.
      ]. SPE is generally defined as a thromboembolus straddling the bifurcation of the main pulmonary artery trunk. Conversely, central PE is diagnosed when thrombi are visualized at computed tomography angiography (CTA) in the main trunk and/or in right or left main pulmonary arteries [
      • Kanjanauthai S.
      • Couture L.A.
      • Fissha M.
      • Gentry M.
      • Sharma G.K.
      Saddle pulmonary embolism visualized by transthoracic echocardiography.
      ]. Its real epidemiology has not yet been assessed since, very frequently, the diagnosis is established at autopsy. As matter of fact, different studies have included SPE patients into the more general group of “central embolism”, confounding the final results [
      • Kwak M.K.
      • Kim W.Y.
      • Lee C.W.
      • Seo D.W.
      • Sohn C.H.
      • Ahn S.
      • et al.
      The impact of saddle embolism on the major adverse event rate of patients with non-high-risk pulmonary embolism.
      ]. As results, available data regarding the short-term outcome of SPE patients are scant and controversial.

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