Tracing the Evolution of Mechanical Advanced Treatment from Pharmaco-Invasive Therapies to Endovascular Thrombectomy in Pulmonary Embolism Management

Pulmonary embolism (PE) presents significant risks when escalating to a high-risk state, demanding immediate and effective intervention. Over the years, remarkable advancements in pharmaco-invasive therapies and mechanical treatment approaches have transformed outcomes for patients grappling with severe PE. This Research Topic aims to offer a comprehensive historical overview, highlighting the evolution of these therapies from conceptual inception to modern clinical application, focusing specifically on modalities such as catheter-directed thrombolysis, EKO-assisted catheter-directed thrombolysis, and endovascular thrombectomy.

Incorporating historical exploration and analysis of mechanical thrombi fragmentation, the utilization of reduced-dose thrombolytic agents like alteplase, and the role of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in treatment paradigms, this review will also emphasize evidence for the safety and efficacy of endovascular thrombectomy using various devices. Given its potential as a treatment of choice, especially for patients on ECMO, integrating this approach within the scope further enhances the topical relevance of this volume.

This historical dissection aims to identify pivotal technological advancements, explore key breakthroughs and ongoing debates, and recognize ethical and safety considerations that have marked the field over the decades. By acknowledging these dimensions, the research aims to inform current practices by highlighting their historical roots, thereby enriching the understanding of contemporary treatment paradigms and the innovative milestones leading to current standards of care.

Scope of Research:

o Historical Development:
o Tracing the origins and evolution of pharmaco-invasive therapies, including catheter-directed thrombolysis and EKO-assisted catheter-directed thrombolysis, for pulmonary embolism.
o Highlighting historical key milestones and pivotal turning points in treatment approaches.

o Technological Advancements:
o Examination of innovations in mechanical thrombi fragmentation, thrombolytic therapy, and endovascular thrombectomy.
o Analysis of the integration and impact of VA-ECMO on treatment outcomes and the role of advanced techniques in enhancing patient prognosis.

o Clinical Implementation:
o Exploration of clinical trials and studies that have influenced the adoption and adaptation of these therapies, emphasizing the role of endovascular thrombectomy in contemporary practice.
o Evaluation of clinical guidelines' evolution and their adherence to practice nuances in today's settings.

o Debates and Controversies:
o Discussion of varying medical opinions and unresolved debates throughout the history of this field, particularly regarding the comparative efficacy and safety of thrombectomy vs. traditional approaches.
o Consideration of ethical, safety, and efficacy issues that have arisen with different therapies.

o Contemporary Relevance:
o Understanding how past discoveries inform present-day strategies in high-risk pulmonary embolism management, particularly in the context of endovascular thrombectomy.
o Identifying remaining gaps and potential directions for future research and therapeutic development.

Through this historical expedition, this Research Topic seeks valuable insights into the trajectory of advanced mechanical and pharmaco-invasive therapies for pulmonary embolism. We welcome submissions of reviews, critical analyses, and perspective articles from researchers, clinicians, and historians, all aiming to illuminate this transformative journey from past to present and anticipate future advancements.