Catheter directed thrombolytic therapy and aspiration thrombectomy in intermediate pulmonary embolism with long term results

Abstract

Background: Catheter directed thrombolysis (CDT) and thrombectomy represent well established techniques for the treatment of intermediate pulmonary embolism (IPE). The long-term effect of catheter directed thrombolysis of IPE is unknown. Methods: Clinical, interventional and echocardiographic data from 80 consecutive patients with IPE who were treated with CDT were evaluated. Primary end-points were technical success and major adverse events. Secondary end-points were cardiovascular mortality, all-cause mortality, clinical success, rate of bleeding complications, improvement in pulmonary pressure and echocardiography parameters. CDT completed with alteplase (10 mg bolus and 1 mg/h maintenance dose) through a pigtail catheter for 24 h. After 24 h, control pulmonary angiography was performed. Results: In total, 80 patients with a mean age of 59.0 ± 16.8 years were treated. CDT was successful after the first post-operative day in 72 (90%) patients, but thrombus aspiration and fragmentation was performed due to failed thrombolysis in 8 (10%) patients. Final technical and clinical success was reached in 79 (98.8%) and 77 (96.3%) patients, respectively. The mean CDT time in IPE was 27.8 ± ± 9.6 h. Invasive pulmonary pressure dropped from 57.5 ± 16.7 to 38.9 ± 13.5 (p < 0.001). A caval filter was implanted in 4 (5%) patients. The 1-year major adverse events and cardiovascular mortality rate was 4.0% and 1.4%, respectively. Access site complications (6 major and 6 minor) were encountered in 12 (16.2%) patients. Conclusions: Catheter directed thrombolysis in submassive pulmonary embolism had excellent results. However, additional mechanical thrombectomy was necessary in some patients to achieve good clinical outcomes.

A rare cause of abdominal pain managed unconventionally: acute renal infarction caused by atrial fibrillation: a case report

“…For patients with severe thromboembolism and relatively long embolization time, direct thrombolysis may not be effective, and thrombolysis can be performed after thrombus aspiration through an interventional catheter. Various thrombolytic methods have been reported including local injection of ornithokinin, tissue plasminogen activator, and other thrombolytic drugs, followed by thrombus aspiration, or thrombus aspiration followed by thrombolysis, with possible angioplasty [ 14 ]. Despite aggressive treatment, renal infarction can lead to acute kidney injury, new-onset eGFR < 60 mL/minute/1.73 m 2 and death.…”

A novel hybrid catheter-directed technique to treat intermediate-high risk pulmonary embolism

“…Interventional techniques are focused to quickly relieve blockage and restore pulmonary blood flow with subsequent improvement in hemodynamic status, oxygenation and RV function [ 8 , 9 ]. The use of two catheter-directed techniques, balloon-delivered local thrombolysis and continuous aspiration thrombectomy, during one procedure was unique.…”