{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T10:07:48Z","timestamp":1787652468023,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Traditionally, mechanical thrombectomy performed for pulmonary embolism (PE) necessitates the utilization of iodinated contrast. Intravascular ultrasound (IVUS) has been used as a diagnostic and therapeutic modality in the management of acute high and intermediate-risk PE. Recently, with the shortage of contrast supplies and the considerable incidence of contrast-induced acute kidney injury (CI-AKI), other safer and more feasible IVUS methods have become desirable. The purpose of this systematic review was to evaluate the importance of IVUS in patients with PE undergoing thrombectomy. Methods: Medline\/PubMed, Embase, Scopus, and Google Scholar were searched for review studies, case reports, and case series. Clinical characteristics, outcomes and the usage of IVUS-guided mechanical thrombectomy during the treatment of acute high and intermediate-risk PE were examined in a descriptive analysis. Results: In this systematic review, we included one prospective study, two case series, and two case reports from July 2019 to May 2023. A total of 39 patients were evaluated; most were female (53.8%). The main presenting symptoms were dyspnea and chest pain (79.5%); three patients (7.9%) presented with syncope, one with shock and one with cardiac arrest. Biomarkers (troponin and BNP) were elevated in 94.6% of patients. Most patients (87.2%) had intermediate-risk PE, and 12.8% had high-risk PE. All patients presented with right-heart strain (RV\/LV ratio \u2265 0.9, n = 39). Most patients (56.4%) had bilateral PE. Mechanical thrombectomy was performed using IVUS without contrast utilization in 39.4% of the patients. After the initial learning curve, contrast usage decreased gradually over time. There was a significant decrease in the composite mean arterial pressure immediately following IVUS-guided thrombectomy from 35.1 \u00b1 7.2 to 25.2 \u00b1 8.3 mmHg (p &lt; 0.001). Post-procedure, there was no reported (0%) CI-AKI, no all-cause mortality, no major bleeding, or other adverse events. There was a significant improvement in symptoms and RV function at the mean follow-up. Conclusions: New evidence suggests that IVUS-guided mechanical thrombectomy is safe, with visualization of the thrombus for optimal intervention, and reduces contrast exposure.<\/jats:p>","DOI":"10.3390\/tomography9040111","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T09:03:53Z","timestamp":1689325433000},"page":"1393-1407","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Role of Intravascular Ultrasound in Pulmonary Embolism Patients Undergoing Mechanical Thrombectomy: A Systematic Review"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5315-6426","authenticated-orcid":false,"given":"Rupak","family":"Desai","sequence":"first","affiliation":[{"name":"Division of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3016-0078","authenticated-orcid":false,"given":"Maharshi","family":"Raval","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Landmark Medical Center, Woonsocket, RI 02895, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7470-0179","authenticated-orcid":false,"given":"Kokou Selom","family":"Adompreh-Fia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, UNT-TCU Medical City Arlington, Arlington, TX 76015, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1805-064X","authenticated-orcid":false,"given":"Jai Sivanandan","family":"Nagarajan","sequence":"additional","affiliation":[{"name":"Department of Medicine, SRM Institute of Science and Technology, Chennai 603203, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1125-659X","authenticated-orcid":false,"given":"Nitin","family":"Ghadge","sequence":"additional","affiliation":[{"name":"Independent Researcher, Albany, NY 12205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1668-4120","authenticated-orcid":false,"given":"Ankit","family":"Vyas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX 77701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7298-4246","authenticated-orcid":false,"given":"Akhil","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timir K.","family":"Paul","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Saint Thomas Heart Institute, University of Tennessee Health Sciences Center, Nashville, TN 37205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7729-6247","authenticated-orcid":false,"given":"Rajesh","family":"Sachdeva","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Atlanta VA Medical Center, Decatur, GA 30033, USA"},{"name":"Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (CDC) (2012). 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