A coalition of the willing Inside the collaborative model of PERT


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khilesh K. Sista, MD, FSIR, and James Horowitz, MD, are members of the NYU Langone pulmonary embolism


response team (PERT), a model that brings interventional radiology, pulmonology and cardiac surgery together to improve outcomes for patients with pulmonary embolism. With Dr. Sista’s IR skill set and Dr. Horowitz’s cardiology knowledge, the two have been part of a successful collaboration model for over a decade.


What is it about PE that makes an interdisciplinary approach like PERT so necessary?


Akhilesh K. Sista, MD, FSIR: The beautiful thing about PE is that it has multiple treatments that span different


disciplines. There aren’t many single- entity diseases that have a medical, surgical and interventional treatment option. So it makes each stakeholder in the PERT very important in terms of decision-making.


4 IRQ | WINTER 2022 SUPPLEMENT


Obviously, every PE patient who can be anticoagulated should be. That’s not a multidisciplinary decision. But when you have someone who cannot be anticoagulated, a PE can be disabling or even fatal. That is when coming together and deciding if escalation of therapy—be it catheter-directed therapy or surgery— is salient to the patient’s outcome. Having all stakeholders in the room is crucial and makes PE treatment so ripe for collaboration.


James Horowitz, MD: I agree. Because PE treatment involves so many specialties, PE patients often experience


serial consults. It takes time to call Physician A, who suggests you call Physician B, who wants input from Physician C, who disagrees with the model of treatment or requests additional imaging. It’s like playing telephone, and you lose time—and when you have a sick PE patient who can decompensate quickly, waiting hours for consults is dangerous. When everyone is in the room, those


conversations happen faster and the treatment model can be customized.


It is also important to consider that there aren’t many guidelines that say when to do a thrombectomy, for example, in a complex case. With cardiology patients, I have association guidelines, and even stroke now has guideline-driven interventions. But PE is still a bit of a grey zone, so the benefit of the interdisciplinary approach is that you can leverage every specialty’s knowledge and experience to have a thoughtful discussion on whether or not to intervene.


With so many specialties in the room, is there difficulty reaching consensus? AS: This is where relationships start to matter. When you work in a model like this, you start to develop trust in your colleagues’ institutional knowledge and skills. When one of the pulmonologists says, “I’m worried about this patient,” I listen to that more than anything else. We see a lot of PE patients together, and so our decision-making has evolved as a group. There may have been disagreements at the start, but that’s rare now. We all understand the merits of each other’s therapies and


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