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Catheter-directed embolectomy, fragmentation, and thrombolysis for the treatment of massive pulmonary embolism after failure of systemic thrombolysis Kuo WT; van den Bosch MAAJ; Hofmann LV; Louie JD; Kothary N; Sze DYChest 2008[Aug]; 134 (2): 250-254PURPOSES: The standard medical management for patients in extremis from massive pulmonary embolism (PE) is systemic thrombolysis, but the utility of this treatment relative to catheter-directed intervention (CDI) is unknown. We evaluated the effectiveness of CDI as part of a treatment algorithm for life-threatening PE. METHODS: A retrospective review was performed on 70 consecutive patients with suspected acute PE over a 10-year period (from 1997 to 2006) who had been referred for pulmonary angiography and/or intervention. The criteria for study inclusion were patients who received CDI due to angiographically confirmed massive PE and hemodynamic shock (shock index, > or = 0.9). CDI involved suction embolectomy and fragmentation with or without catheter thrombolysis. RESULTS: Twelve patients were treated with CDI. There were seven men and five women (mean age, 56 years; age range, 21 to 80 years). Seven patients (58%) were referred for CDI after failing systemic infusion with 100 mg of tissue plasminogen activator, and five patients (42%) had contraindications to systemic thrombolysis. Catheter-directed fragmentation and embolectomy were performed in all patients (100%). Additionally, catheter-guided thrombolysis was performed in eight patients (67%). Technical success was achieved in 12 of 12 cases (100%). There were no major procedural complications (0%). Significant hemodynamic improvement (shock index, < 0.9) was observed in 10 of 12 cases (83%). The remaining two patients (17%) died secondary to cardiac arrest within 24 h. Ten of 12 patients (83%) survived and remained stable until hospital discharge (mean duration, 20 days; range, 3 to 51 days). CONCLUSION: In the setting of hemodynamic shock from massive PE, CDI is potentially a life-saving treatment for patients who have not responded to or cannot tolerate systemic thrombolysis.|*Catheterization, Peripheral[MESH]|*Embolectomy[MESH]|*Thrombolytic Therapy[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Algorithms[MESH]|Cohort Studies[MESH]|Female[MESH]|Fibrinolytic Agents/administration & dosage[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Pulmonary Embolism/complications/diagnosis/*therapy[MESH]|Retreatment[MESH]|Retrospective Studies[MESH]|Treatment Failure[MESH] |
