This Article Full Text Full Text (PDF) All Versions of this Article: chest.07-2656v1 134/1/54    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (1) Google Scholar Articles by Eid-Lidt, G. Articles by Martínez-Sánchez, C. PubMed PubMed Citation Articles by Eid-Lidt, G. Articles by Martínez-Sánchez, C. Related Content Related Editorial

Combined Clot Fragmentation and Aspiration in Patients With Acute Pulmonary Embolism^*

^* From the Departments of Interventional Cardiology (Drs. Eid-Lidt, Gaspar, and de los Santos) and Cardiopulmonary Disease (Drs. Sandoval and Pulido), and the Emergency and Coronary Care Unit (Dr. Pacheco and Martínez-Sánchez), Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, Mexico.

Correspondence to: Guering Eid-Lidt, MD, Department of Interventional Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez," Juan Badiano No 1, Tlalpan, CP 14080. Mexico City. México; e-mail: 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.

Methods: Clinical, 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 New York Heart Association functional class, and hospital readmission.

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

Conclusions: In 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.

Key Words: percutaneous mechanical thrombectomy • pulmonary embolism • right ventricular dysfunction

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]