经过一次肺栓塞（PE）之后，残余肺血管阻塞（RPVO）会影响一半的患者。目前尚不清楚危险因素和治疗干预与RPVO和慢性血栓栓塞性肺动脉高压（CTEPH）的发展之间的关系。本回顾性研究纳入了一个26个月期间接受基线和随访影像学（计算机断层扫描[CT]、通气/灌注[V/Q]、经胸超声心动图[TTE]）的PE患者。我们收集了RPVO的发生率、肺动脉阻塞百分比（%PAO）、基线CT的%PAO（α%PAO）、最近CT的%PAO（Ω%PAO）以及最近与基线CT的%PAO之间的差异（Δ%PAO）。共有354名患者有影像学报告，197名患者有CT图像，315名患者有TTE。中位数（IQR）的随访时间为144（102-186）天。RPVO的发生率为38.9%。中位数Δ%PAO为-10.0（-32─-1.2）。在接受刺激的PE患者中，发生RPVO的患者较少（p=<0.01），发生RPVO的患者初始肌钙蛋白较低（p=0.03）。接受高级治疗干预与接受抗凝治疗相比，初始血栓较大（α%PAO 61.2[27.5-75.0] vs. 12.5 [2.5-40.0]；p=<0.0001）。导管导向的溶栓术（CDT）（Δ%PAO -47.5(-63.7 - -8.7)）和肺血栓切除术（SPE）（Δ%PAO -42.5(-68.1- -18.7)）与抗凝治疗相比，在溶栓术上具有最大的溶栓作用（p=0.01）。76名患者发生肺动脉高压（PH），但只有14名患者接受了PH药物治疗，12名患者接受了肺内血栓切除。癌症（OR 1.7）和计划进行长期抗凝治疗（>1年）（OR 2.20）增加了RPVO的风险；相反，男性（OR 0.61）、最近接受手术的患者（OR 0.33）以及接受肺血栓切除术的患者（OR 0.42）的风险较低。男性（系数-8.94）、BMI较低的患者（系数-0.66）、接受CDT的患者（系数-18.12）和接受SPE的患者（系数-21.69）具有更大的Δ%PAO。非洲裔美国人患者的Δ%PAO较低（系数7.31）。结论：导管导向的溶栓术和肺血栓切除术在溶栓作用方面表现出长期的益处。Copyright © 2023. Published by Elsevier Inc.

Residual pulmonary vascular occlusion (RPVO) affects half of patients after a pulmonary embolism (PE). The relationship between risk factors and therapeutic interventions with the development of RPVO and chronic thromboembolic pulmonary hypertension (CTEPH) is unknown.This retrospective review included PE patients within a 26-month period who had a baseline and follow-up imaging (computer tomography [CT], ventilation/perfusion [V/Q], transthoracic echocardiograms [TTE]). We collected the incidence of RPVO, the % pulmonary artery occlusion (%PAO), baseline CT %PAO (α%PAO), most recent CT %PAO (Ω%PAO), and the difference most recent-baseline CT %PAO (Δ%PAO).There were 354 patients with imaging reports, 197 patients with CT images, and 315 patients with TTE. The median (IQR) follow-up time was 144 (102-186) days. RPVO was present in 38.9%. The median Δ%PAO was -10.0(-32 ─ -1.2). Less patients with a provoked PE developed RPVO (p=<0.01), and initial troponin was lower in patients who developed RPVO (p=0.03). Initial thrombus was larger in patients who received advanced interventions vs. anticoagulation (α%PAO 61.2[27.5-75.0] vs.12.5 [2.5-40.0]; p=<0.0001). Catheter-directed thrombolysis (CDT) (Δ%PAO -47.5(-63.7 - -8.7) and surgical pulmonary embolectomy (SPE) (Δ%PAO -42.5(-68.1- -18.7) had the largest thrombus reduction compared with anticoagulation (p=0.01). 76 patients developed pulmonary hypertension (PH), but only 14 received PH medications and 12 underwent pulmonary thromboendarterectomy. Cancer (OR 1.7) and a planning prolonged anticoagulation (>1year) (OR 2.20) increased the risk of RPVO; In contrast, the risk was lower in males (OR 0.61), patients with recent surgeries (OR 0.33), and patients treated with SPE (OR 0.42). A larger Δ%PAO was found in males (coefficient -8.94), patients with a lower BMI (coefficient -0.66), patients treated with CDT (coefficient -18.12) and SPE (coefficient -21.69). A lower Δ%PAO was found in African American patients (coefficient 7.31) CONCLUSION: The use of catheter-directed thrombolysis and surgical pulmonary embolectomy showed a long-term benefit in thrombus reduction.Copyright © 2023. Published by Elsevier Inc.