{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:32:45Z","timestamp":1793946765338,"version":"4.8.0"},"reference-count":0,"publisher":"Kare Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Anatol J Cardiol"],"abstract":"<jats:p>Background: Comparative data on ultrasound-assisted catheter-directed thromboly-sis (USAT) and systemic low-dose tissue-type plasminogen activator (tPA) for intermediate-high-risk (IHR) pulmonary embolism (PE) remain limited. The efficacy and safety outcomes of USAT vs. intravenous (IV) low-dose tPA were evaluated in this population.\n\nMethods: This study enrolled 329 IHR PE patients treated with USAT (n = 205) or IV low-dose tPA (n = 124). Post-treatment changes in clot burden (Qanadli score), right ventricular (RV) strain, and long-term mortality (median follow-up 95.8 months) were assessed. Propensity score analysis with inverse probability weighting (IPW) was employed to adjust for confounders.\n\nResults: Ultrasound-assisted catheter-directed thrombolysis was predominantly bilateral (82.9%), with a mean tPA dose of 38.5 \u00b1 13.6 mg. In the IV tPA cohort, 58.9% required a second infusion to achieve stabilization. While IV tPA was associated with more pronounced early reductions in heart rate and RV\/LV (left ventricle) ratio, USAT provided significantly greater thrombus resolution (all P &lt; .005). After IPW adjustment, USAT demonstrated clear superiority over IV tPA in reducing residual clot burden (P &lt; .001). However, improvements in oxygen saturation, tricuspid annular plane systolic excursion , and pulmonary artery systolic pressure (PASP) were comparable. No significant differences were observed in in-hospital mortality, PE recurrence, or long-term survival between cohorts. Higher PE severity indexes scores independently predicted in-hospital adverse events, whereas older age, male sex, and higher discharge PASP were predictors of shortened long-term survival.\n\nConclusions: In IHR PE, IV low-dose tPA relates to more pronounced early hemodynamic and RV diameter improvements, whereas USAT achieves superior thrombus resolution. Despite these divergent surrogate responses, both strategies yield comparable early and long-term clinical outcomes, supporting their roles as viable reperfusion options.<\/jats:p>","DOI":"10.14744\/anatoljcardiol.2026.6510","type":"journal-article","created":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:19:03Z","timestamp":1793945943000},"source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-Assisted Catheter-Directed Thrombolysis vs. Low-Dose Intravenous Tissue-Type Plasminogen Activator Treatments in Acute Intermediate-High Risk Pulmonary Embolism: Insights from a Retrospective Study"],"prefix":"10.14744","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2627-9081","authenticated-orcid":false,"given":"Cihangir","family":"Kaymaz","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ba\u015fkent University \u0130stanbul Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1424-2209","authenticated-orcid":false,"given":"Bark\u0131n","family":"K\u00fclt\u00fcrsay","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tunceli State Hospital, Tunceli, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8187-7290","authenticated-orcid":false,"given":"Hacer\u00a0Ceren","family":"Tokg\u00f6z","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0933-9233","authenticated-orcid":false,"given":"Seda","family":"Tanyeri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5879-2245","authenticated-orcid":false,"given":"Berhan","family":"Keskin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medipol University, Faculty of Medicine, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2433-3593","authenticated-orcid":false,"given":"\u00c7a\u011fda\u015f","family":"Bulu\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2529-4995","authenticated-orcid":false,"given":"\u00c7a\u011flar\u00a0Emre","family":"\u00c7a\u011fl\u0131yan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u00c7ukurova University, Faculty of Medicine, Adana, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4432-4595","authenticated-orcid":false,"given":"Deniz","family":"Mutlu","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, Mount Sinai Hospital, Newyork City, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2569-8295","authenticated-orcid":false,"given":"Simay","family":"Erdal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5357-7076","authenticated-orcid":false,"given":"Faruk","family":"Akal\u0131n","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2718-8806","authenticated-orcid":false,"given":"R\u0131dvan","family":"Bolataslan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8252-0373","authenticated-orcid":false,"given":"Aykun","family":"Hakg\u00f6r","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medipol University, Faculty of Medicine, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6435-7821","authenticated-orcid":false,"given":"\u015eeyhmus","family":"K\u00fclahc\u0131o\u011flu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4546-9227","authenticated-orcid":false,"given":"\u0130brahim\u00a0Halil","family":"Tanbo\u011fa","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Biostatistics, Faculty of Medicine, Atlas University, \u0130stanbul, Tu\u0308rkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6337-7716","authenticated-orcid":false,"given":"Nihal","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, \u0130stanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5966","published-online":{"date-parts":[[2026]]},"container-title":["The Anatolian Journal of Cardiology"],"original-title":[],"link":[{"URL":"https:\/\/file.paplino.com\/anatoljcardiol\/pdfs\/1786021177-en.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:19:03Z","timestamp":1793945943000},"score":1,"resource":{"primary":{"URL":"https:\/\/anatoljcardiol.com\/article\/AJC-22473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"URL":"https:\/\/doi.org\/10.14744\/anatoljcardiol.2026.6510","relation":{},"ISSN":["2149-2271","2149-2263"],"issn-type":[{"value":"2149-2271","type":"print"},{"value":"2149-2263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}