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Rheolytic thrombectomy in patient with massive pulmonary embolism: a case report and review of literature. Catheter Cardiovasc Interv 2007 Nov 15;70(6):802-6

Date

11/21/2007

Pubmed ID

18022902

DOI

10.1002/ccd.21342

Scopus ID

2-s2.0-38049046084   10 Citations

Abstract

OBJECTIVE: Despite advances in management with thrombolytic therapy or open embolectomy, the mortality rate remains high in patients with massive pulmonary embolism (MPE).

BACKGROUND: We present a case of 51-year-female patient who collapsed while jogging and was brought to the Emergency Department. Upon arrival, she was found to have marked hypotension and hypoxia. EKG showed marked ST T abnormalities suggestive of anterior and lateral ischemia. Blood was drawn for labs. Patient received aspirin, heparin, and was transferred to cardiac catheterization laboratory.

METHODS: Coronary angiogram revealed normal epicardial coronaries. A pigtail catheter was inserted through right femoral vein and pulmonary angiogram was performed. It revealed bilateral MPE. Tissue plasminogen activator was initiated as per standard protocol. A 7-French aspiration catheter (Export, Medtronic Vascular, Santa Rosa, CA) was used without any success. Rheolytic thrombectomy (RT) (AngioJet, Possis, Minneapolis, MN) was performed successfully with adjunctive local and systemic thrombolytic therapy. Immediate pulmonary angiogram showed increased perfusion through right pulmonary artery. Her hemodynamic status improved significantly. Patient was discharged home after 8 days of hospitalization. Patient remains on lifelong anticoagulation therapy and she continues to remain stable at 20 months follow up.

CONCLUSIONS: RT with adjunctive localized and systematic thrombolytic therapy was performed successfully in this patient with MPE and significant hemodynamic compromise. In our patient who was very unstable from cardio-respiratory perspective with maximized hemodynamic support, RT device use was life saving. RT has an advantage of not dispersing emboli particles to the distal pulmonary circulation.

Author List

Brahmbhatt T, Tutton S, Mannebach P, Cinquegrani M

Author

Sean Tutton MD Vice Chair, Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Angiography
Catheterization
Female
Fibrinolytic Agents
Follow-Up Studies
Humans
Infusions, Intravenous
Middle Aged
Pulmonary Embolism
Severity of Illness Index
Thrombectomy
Tissue Plasminogen Activator
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280