[Mechanical recanalization and local thrombolysis in a patient with fulminant pulmonary embolism and craniocerebral trauma].
A 77-year-old female patient presenting with recurrent pulmonary embolism and shock had a severe craniocerebral trauma after collapsing at home 2 days before admission. Since systemic thrombolytic therapy appeared hazardous in this patient, percutaneous fragmentation and distal dispersion of the proximal pulmonary emboli was performed using a pigtail catheter. This procedure improved cardiac output immediately by 15%, whereas the mean pulmonary artery pressure dropped only slightly from 48 to 46 mmHg. Thereafter, a streptokinase infusion of 100,000 IU during 1 h was instituted through the pigtail catheter into the pulmonary artery. 12 hours after the treatment was started, cardiac output was raised by 70% and mean pulmonary artery pressure was decreased from 48 to 25 mmHg. 14 days after admission, control ventilation-perfusion scan showed a markedly improved pulmonary perfusion, and right heart catheterization revealed normal right heart pressures. The patient recovered rapidly and there was no evidence of recurrent pulmonary embolism 18 months later. This report demonstrates that a percutaneous catheter fragmentation of proximal pulmonary emboli combined with local intermediate-dose infusion of streptokinase may be a helpful therapeutic option in patients with massive pulmonary embolism in whom systemic thrombolytic therapy is contraindicated.
Manthey
J
J
Abt. Innere Medizin/Kardiologie, Kreiskrankenhaus am Plattenwald, Bad Friedrichshall.
Fröhlich
G
G
Mautner
J P
JP
Munderloh
K H
KH
Zimmermann
R
R
D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation; D003131:Combined Modality Therapy; D017128:Embolectomy; D005260:Female; D016489:Head Injuries, Closed / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006801:Humans; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000628:therapy*; D011877:Radionuclide Imaging; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy
D013300:Streptokinase
Mechanische Rekanalisation und lokale Thrombolyse bei einer Patientin mit fulminanter Lungenembolie und Schädeltrauma.