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Hani Al-Terki, Abdelrahman Elhakim, Andreas Mügge

• Background: Pulmonary embolism (PE) is a common cardiovascular disease. Elderly patients with acute PE have very high mortality rates. Data concerning the safety and effectiveness of ultrasound-accelerated thrombolysis (USAT) in this age group are lacking. Methods: Nineteen octogenarians with acute pulmonary embolism underwent USAT between August 2020 and February 2023 at two centres in Germany and were retrospectively analysed. The main efficacy measures were the right ventricle to left ventricle diameter (RV/LV) ratio, systolic right ventricle function, and invasive and echocardiographic measured systolic pulmonary artery pressure (sPAP). The main safety measures were in-hospital death and the bleeding rate according to the GUSTO bleeding score. Results: USAT was associated with an improved RV/LV ratio (0.36 \(\pm\) 0.29, \(\it p\) < 0.001), systolic right ventricle function (5.0 \(\pm\) 3.8, \(\it p\) < 0.001), and systolic pulmonary artery pressure (sPAP) at 24 h after therapy (24.2 \(\pm\) 11.2 mmHg and 19 \(\pm\) 13.4 mmHg, \(\it p\) < 0.001). No in-hospital deaths or bleeding complications occurred. Conclusions: USAT with \(EKOS^{TM}\) may be a safe and effective therapeutic option for octogenarians with acute pulmonary embolism.