Mechanical and Enzymatic Thrombolysis for Massive Pulmonary Embolism

Hybrid treatment with angiographic catheter in massive pulmonary embolism: mechanical fragmentation and fibrinolysis

“…In addition, both during and at the end of the rotations, we were able to verify the drop in mean pulmonary artery pressure values, improvement of haemodynamic state and peripheral dislocation of the smaller emboli in real time. Other studies have reported similar behaviour using conventional angiographic catheters [4,[15][16][17][18][19] or devices for mechanical thrombolysis [6,20,21].…”

“…The different response of the emboli to mechanical fragmentation prompts a number of considerations that may have repercussions for the later management of the patient. On the basis of our experience and several studies published in the literature [6,16,17,28], pulmonary emboli and their behaviour following mechanical fragmentation can be divided into four classes: -Type I: recently formed (<5 days) and unorganised thrombi which have recently embolised. Present in 68 of our patients (41%), this group best responded to mechanical fragmentation with the pigtail catheter alone.…”

Síncope e bloqueio atrioventricular total relacionado a tromboembolismo pulmonar

“…As it indicates a massive and acute vascular obstruction, the authors proposed the need for immediate pulmonary angiography, aiming at assessing a possible surgical correction through pulmonary embolectomy 13 . Because approximately 2/3 of the patients with massive pulmonary thromboembolism die in the first hour, fast diagnosis and therapeutic intervention at the time of pulmonary embolism presentation are essential 12 . According to the multicenter study Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED), pulmonary thromboembolism is not a disease that can be clinically diagnosed, and ventilation/perfusion scintigraphy in combination with clinical suspicion is occasionally useful, but most patients need to undergo pulmonary angiography so a more accurate diagnosis may be established 2 .…”

“…This failure could trigger a significant decrease in left ventricular filling, with concomitant tachycardia, arterial hypotension, and low cerebral flow 3,9 , which may be the most probable mechanism of syncope in the presence of acute pulmonary thromboembolism 1 . In addition to the hemodynamic alterations, respiratory disorders, such as bronchoconstriction, an increase in the dead space, and a reduction in the pulmonary surfactant contribute to the clinical findings in these patients 12 .…”

“…The justification for this combined intervention was that the mechanical fragmentation of the thrombus could allow rapid recanalization of the central pulmonary arteries. In addition, rupture of the thrombus could cause dispersion of the clot to more peripheral branches, generating a decrease in pulmonary artery pressure and an increase in pulmonary vascular flow 12 . Finally, mechanical fragmentation, theoretically, could also allow an increase in the area of the thrombus exposed to the fibrinolytic agent, therefore increasing its lytic action 12 .…”