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Combined clot fragmentation and aspiration in patients with acute pulmonary embolism.

¹Department of Interventional Cardiology. Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico ².Department of Cardiopulmonary Disease. Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico ³Department of Emergency and Coronary Care Unit. Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico

guering{at}yahoo.com

Abstract

Background Massive angiographic pulmonary embolism (PE) with right ventricular dysfunction (RVD) is associated with a high early mortality rate. The therapeutic alternatives for this condition include thrombolysis, surgical embolectomy, or percutaneous mechanical thrombectomy (PMT). We describe our experience using PMT in patients with massive PE and RVD with unsuccessful thrombolysis, increased bleeding risk or major contraindications for thrombolytic therapy.

MethodsClinical, hemodynamic and angiographic parameters prior to, and following PMT were evaluated. Our primary objective was to describe the incidence of in-hospital cardiovascular death, and of major and minor complications. Mid-term outcomes included analysis of occurrence of cardiovascular death, recurrent pulmonary embolism, change of NYHA functional class and hospital readmission.

ResultsFrom July 2004 to May 2007, 69 patients were referred to the cardiac catheterization laboratory with a diagnosis of acute PE, of which 18 met the criteria for massive PE and are the subject of this study. All patients underwent thrombus fragmentation using a pigtail catheter which was complemented in 13 patients with thrombus aspiration. The Aspirex ® percutaneous thrombectomy device was used in 11 patients. Hemodynamic, angiographic and blood oxygenation parameters improved after the procedure. A significant increase was observed for systolic systemic blood pressure ( 74.3 ± 7.5 vs 89.4 ± 11.3, p=0.001), as was a decrease in mean pulmonary artery pressure (37.1 ± 8.5 vs 32.3 ± 10.5, p=0.0001). In-hospital major complications rate was 11.1%; one patient died from refractory shock and one had intracerebral hemorrage with minor neurological sequelae. No cardiovascular death or recurrent pulmonary thromboembolism was documented during clinical follow-up (12.3 ± 9.4 months).

ConclusionsIn patients with massive PE, RVD and major contraindications to thrombolytic therapy, increased bleeding risk, failed thrombolysis or unavailable surgical thrombectomy, PMT appears to be a useful therapeutic alternative.

Related Editorial

Mechanical Catheter Intervention in Massive Pulmonary Embolism: Proof of Concept

Nils Kucher and Samuel Z. Goldhaber
Chest 2008 134: 2-4. [Full Text] [PDF]

This article has been cited by other articles:

				N. Kucher and S. Z. Goldhaber Mechanical Catheter Intervention in Massive Pulmonary Embolism: Proof of Concept Chest, July 1, 2008; 134(1): 2 - 4. [Full Text] [PDF]