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2016 ; 12
(4
): 219-224
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Interventional Therapy for Pulmonary Embolism
#MMPMID28289497
Lumsden AB
; Suarez E
Methodist Debakey Cardiovasc J
2016[Oct]; 12
(4
): 219-224
PMID28289497
show ga
Patients with pulmonary embolism (PE) present with highly variable clinical
symptoms and often have accompanying comorbidities. Timely diagnosis and
treatment are critical to help prevent recurrence and increased
morbidity/mortality. While open surgical thrombectomy was once reserved only for
those with massive PE and hemodynamic compromise, it has been reevaluated with a
focus on careful patient selection and early intervention. Lately, there has been
increased interest in catheter-based interventions and in combining these with an
open surgical component to decrease the magnitude of the intervention-for
example, direct placement of large-bore thrombectomy devices directly into the
right ventricle via sternotomy or subxiphoid approaches. In addition, improved
diagnostic capabilities have allowed for expedited diagnosis and treatment of
patients with life-threatening PE. At our institution, a hybrid room allows
patients suspected of having a massive or submassive PE to undergo on-table
contrast-enhanced cone-beam computed tomography scan, thus creating a
high-resolution 3-dimensional image of the arterial system that can provide
immediate guidance for therapeutic intervention. This review highlights the array
of therapeutic options currently used in our armamentarium at the Houston
Methodist DeBakey Heart & Vascular Center and describes our development of a
pulmonary angioplasty procedure that we believe will greatly facilitate selective
thrombus removal in the acute PE setting.
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