Novel percutaneous catheter thrombectomy in acute massive pulmonary embolism: Rotational bidirectional thrombectomy (ROBOT)

Yoshida, Masashi; Inoue, Ichiro; Kawagoe, Takuji; Ishihara, Masaharu; Sakai, Yuji; Kurisu, Satoshi; Kusano, Kengo; Ohe, Tohru

doi:10.1002/ccd.20747

Cited by 14 publications

(5 citation statements)

References 39 publications

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“…If thrombolysis fails or is contraindicated, surgical embolectomy is indicated in centers where an experienced cardiac surgical team is available (119). Percutaneous mechanical clot disruption also has been reported, but data comparing outcomes to pharmacologic thrombolysis or surgical thrombectomy are limited (129,130). In submassive pulmonary embolism associated with echocardiographic evidence of right ventricular strain but without hemodynamic instability, thrombolysis is recommended by some, although this remains controversial (131).…”

Section: Pulmonary Embolismmentioning

confidence: 97%

Management strategies for patients with pulmonary hypertension in the intensive care unit*

Zamanian

Haddad

Doyle

et al. 2007

Critical Care Medicine

188

161

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Pulmonary hypertension presents a particular challenge in critically ill patients, because typical therapies such as volume resuscitation and mechanical ventilation may worsen hemodynamics in patients with pulmonary hypertension and right ventricular failure. Patients with decompensated pulmonary hypertension, including those with pulmonary hypertension associated with cardiothoracic surgery, require therapy for right ventricular failure. Very few human studies have addressed the use of vasopressors and pulmonary vasodilators in these patients, but the use of dobutamine, milrinone, inhaled nitric oxide, and intravenous prostacyclin have the greatest support in the literature. Treatment of pulmonary hypertension resulting from critical illness or chronic lung diseases should address the primary cause of hemodynamic deterioration, and pulmonary vasodilators usually are not necessary.

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Section: Pulmonary Embolismmentioning

confidence: 97%

Management strategies for patients with pulmonary hypertension in the intensive care unit*

Zamanian

Haddad

Doyle

et al. 2007

Critical Care Medicine

188

161

View full text Add to dashboard Cite

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“…17) Although there are a few studies 18,19) describing the clinical benefits of thrombectomy using other kinds of catheters, this procedure was rarely undertaken in pregnant patients in the literature. It was performed quickly and safely and the hemodynamics recovered dramatically.…”

Section: Discussionmentioning

confidence: 99%

Massive Pulmonary Thromboembolism in Pregnancy Rescued Using Transcatheter Thrombectomy

et al. 2007

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SUMMARYWe report a rescued 37-year-old woman in her 30 th week of gestation with massive pulmonary thromboembolism who was admitted to our cardiac care unit with progressive dyspnea and 2 episodes of syncope. Helical chest CT showed massive pulmonary thromboembolism of both pulmonary arteries. Although 26,000 U/day of heparin was administered following insertion of a temporary filter, hemodynamic evaluation documented no improvement. Since pulmonary artery (PA) pressure increased from 62/22 mmHg to 80/ 24 mmHg just after an emergency cesarean section on day 2, an emergency transcatheter thrombectomy was performed and it showed decreased PA pressure following extensive thrombus aspiration. Mother and baby were discharged with no complications.(Int Heart J 2007; 48: [269][270][271][272][273][274][275][276]

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“…Unlike patients with acute pulmonary hypertension [13], patients who develop acute pulmonary hypertension on top of preexisting pulmonary hypertension can generate higher PAP and also require higher RV preload (because of RV hypertrophy). Therapy for acute massive PE with associated hemodynamic instability or cardiogenic/obstructive shock aims at urgently relieving mechanical obstruction of the pulmonary circulation by either pharmacologic thrombolytic or by surgical or catheter thrombectomy (or mechanical clot disruption) [46,71,72]. Patients with massive PE but without hemodynamic instability are less likely to benefit from thrombolytic therapy.…”

Section: General Management Principlesmentioning

confidence: 99%

The Management of Acute Pulmonary Arterial Hypertension

Gan

2010

Cardiovascular Therapeutics

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Acute pulmonary arterial hypertension (PAH), which may complicate the course of many complex disorders, is always underdiagnosed and its treatment frequently begins only after serious complications have developed. Acute PAH is distinctive because they differ in their clinical presentation, diagnostic findings, and response to treatment from chronic PAH. The acute PAH may take either the form of acute onset of chronic PAH or acute PAH or surgeryrelated PAH. Significant pathophysiologic differences existed between acute and chronic PAH. Therapy of acute PAH should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. There are three classes of drugs targeting the correction of abnormalities in endothelial dysfunction, which have been approved recently for the treatment of PAH: (1) prostanoids; (2) endothelin receptor antagonists; and (3) phosphodiesterase-5 inhibitors. The efficacy and safety of these compounds have been confirmed in uncontrolled studies in patients with PAH. Intravenous epoprostenol is suggested to serve as the first-line treatment for the most severe patients. In the other situations, the first-line therapy may include bosentan, sildenafil, or a prostacyclin analogue. Recent advances in the management of PAH have markedly improved prognosis.Pulmonary arterial hypertension (PAH) is a progressive, symptomatic, and ultimately fatal disorder for which substantial advances in treatment have been made during the past decade [1]. Despite advances in the management of PAH, the mortality rate remains excessive. Acute PAH, which may lead to refractory systemic arterial hypotension, severe hypoxemia, right ventricular (RV) dysfunction and failure, and ultimately result in cardiogenic and/or obstructive shock and death have always been neglected until serious complications have developed. Effective management requires timely recognition and accurate diagnosis of the disorder and appropriate selection among therapeutic alternatives. Despite progress in treatment, obstacles remain that impede the achievement of optimal outcomes [2]. The pathophysiology, monitoring, and management of the acute pulmonary hypertension are reviewed in this article to highlight the importance and due management of it. The article also reviews established approaches to evaluation and treatment, with emphasis on the appropriate application of calcium channel blockers (CCBs), prostacyclin analogues, endothelin receptor antagonists (ETRAs), and phosphodiesterase 5 inhibitors. Pathophysiology and Pathogenesis of Acute PAHPAH is characterized by elevated pulmonary arterial pressure (PAP) and secondary RV failure. The definition of PAH used in clinical trials has been a mean pulmonary arterial pressure (mPAP) >25 mmHg at rest or >30 mmHg with exercise, a pulmonary capillary wedge pressure (PCWP) of <15 mmHg, and a pulmonary vascular resistance (PVR) of >3 Wood units, which has been attributed to the criteria for idiopathic PAH established by the National Institutes of Health Regis...

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Novel percutaneous catheter thrombectomy in acute massive pulmonary embolism: Rotational bidirectional thrombectomy (ROBOT)

Abstract: ROBOT therapy results in a significant, rapid improvement in the hemodynamic situation and in a better outcome than conventional therapy in patients with acute massive pulmonary embolism.

Cited by 14 publications

References 39 publications

Management strategies for patients with pulmonary hypertension in the intensive care unit*

Management strategies for patients with pulmonary hypertension in the intensive care unit*

Massive Pulmonary Thromboembolism in Pregnancy Rescued Using Transcatheter Thrombectomy

The Management of Acute Pulmonary Arterial Hypertension

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