BackTable / VI / Podcast / Episode #386
The PERT Approach: Innovating on Acute PE Management
with Dr. Robert Lookstein
In this episode, host Dr. Chris Beck interviews Dr. Robert Lookstein about the pulmonary embolism response team (PERT) approach for treating acute pulmonary embolisms (PE). Dr. Lookstein is a practicing interventional radiologist in New York City at Mount Sinai Icahn School of Medicine.
BackTable, LLC (Producer). (2023, November 20). Ep. 386 – The PERT Approach: Innovating on Acute PE Management [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Robert Lookstein
Dr. Robert Lookstein is the executive vice chairman of the department of diagnostic, molecular, and interventional radiology at Icahn School Medicine at Mount Sinai in New York City.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
We begin the episode by learning how Dr. Lookstein became involved in the PE space and how acute PE management has evolved. Dr. Lookstein breaks down the PERT at Mount Sinai, PERTs at other academic institutions, and the core qualities of a strong PERT. He walks us through a typical PE presentation, the process of PERT activation, and the workup with risk stratification. Dr. Lookstein also shares a few physical examination pearls for evaluating patients with PE and teasing out acuity vs. chronicity of presentation .
Dr. Lookstein and Dr. Beck discuss endovascular PE interventions - ultrasound accelerated thrombolysis (trade name: EKOS catheter, Boston Scientific), first generation and second generation thrombectomy systems. The doctors also cover how advancements in technology have made these large-bore thrombectomy devices easier to learn about and use. Looking towards the horizon, Dr. Lookstein shares what we can expect from third generation technologies.
We highlight how the primary endpoint of the PERT is to relieve the strain and stabilize/preserve the function of the right ventricle, regardless of how much clot is removed/remains. The doctors discuss the possibility of combined treatment algorithms for PE and the clinical data that has guided PERTs (all linked in resources below). To conclude the episode, Dr. Lookstein shares follow-up, longitudinal care, and how to tackle clot-in-transit.
EKOS Endovascular System Boston Scientific
PEERLESS II Trial:
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