Simultaneous mechanical clot fragmentation and pharmacologic thrombolysis in acute massive pulmonary embolism

Essop, Mohammed R.; Middlemost, Shirley; Skoularigis, John; Sareli, Pinhas

doi:10.1016/0002-9149(92)90251-s

Cited by 50 publications

(20 citation statements)

References 7 publications

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“…The patient was infused with intravenous heparin to maintain the activated partial thromboplastin time 1.5 times above normal. Mechanical thrombolysis is an effective endovascular procedure with specific indications [52,53,54,55]. The thrombolysis can be considered complete when 95% of the thrombus has disappeared.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of superior vena cava syndrome using metallic stents

et al. 2003

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Section: Discussionmentioning

confidence: 99%

Percutaneous treatment of superior vena cava syndrome using metallic stents

et al. 2003

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“…Streptokinase was then administered to two of the patients. Essop et al reported five patients with massive PE treated with thrombus fragmentation using standard guidewires and catheters followed by a bolus of 600,00 U of streptokinase over 30 min and streptokinase infusion at 100,00 U/h for 12 h [26]. Angiographic appearances improved, systemic blood pressure increased and right ventricular end diastolic and pulmonary artery pressures fell following mechanical clot fragmentation and administration of the bolus dose of streptokinase.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

et al. 1999

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The purpose of this article is to report four patients with massive pulmonary embolism treated with percutaneous catheter and guidewire fragmentation and local administration of recombinant tissue plasminogen activator (r-TPA). Four patients with massive pulmonary embolism initially underwent pulmonary angiography. Thrombus fragmentation was performed with both standard angiographic guidewires and catheters followed by local infusion of 41-200 mg of r-TPA. Pulmonary angiography was repeated after treatment. All patients survived with improvement in their clinical status and eventual discharge from hospital. Angiography in all patients post treatment demonstrated improvement in pulmonary perfusion (mean Miller score before treatment 22.5; mean Miller score after treatment 5.75). No patient had a significant complication. Mechanical fragmentation of the thrombus followed by local infusion of r-TPA was an effective treatment for massive pulmonary embolism in these four patients with no significant complications.

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“…The disadvantage of this therapy is the time delay between the beginning of fibrinolytic therapy and clot lysis. Although intrapulmonary infusion of rtPA does not offer a significant benefit over the intravenous route [4], the additional use of mechanical clot fragmentation quickly increases pulmonary blood flow and decreases right ventricular afterload [5]. A further advantage may be enhanced exposure of the fragmented emboli to the lytic agent due to the larger surface area.…”

Section: Discussionmentioning

confidence: 99%

“…The intervention can be performed immediately after diagnostic angiography. The effectiveness of combined clot fragmentation and local fibrinolysis has been demonstrated with the use of streptokinase and urokinase as fibrinolytic drugs [1,[5][6][7]. One study with the use of intravenous rtPA showed some advantages, with a more rapid and safer action compared with urokinase [8].…”

Section: Discussionmentioning

confidence: 99%