title: Massive pulmonary embolism: treatment with thrombus fragmentation and local fibrinolysis with recombinant human-tissue plasminogen activator.
abstract: OBJECTIVE
  To report the results of thrombus fragmentation in combination with local fibrinolysis using recombinant human-tissue plasminogen activator (rtPA) in patients with massive pulmonary embolism.
  
  
  METHODS
  Five patients with massive pulmonary embolism were treated with thrombus fragmentation followed by intrapulmonary injection of rtPA. Clot fragmentation was performed with a guidewire, angiographic catheter, and balloon catheter. Three patients had undergone recent surgery; one of them received a reduced dosage of rtPA.
  
  
  RESULTS
  All patients survived and showed clinical improvement with a resultant significant (p < 0.05) decrease in the pulmonary blood pressure (mean systolic pulmonary blood pressure before treatment, 49 mmHg; 4 hr after treatment, 28 mmHg). Angiographic follow-up in three patients revealed a decrease in thrombus material and an increase in pulmonary perfusion. Two patients developed retroperitoneal hematomas requiring transfusion.
  
  
  CONCLUSIONS
  Clot fragmentation and local fibrinolysis with rtPA was an effective therapy for massive pulmonary embolism. Bleeding at the puncture site was a frequent complication.
authors.affiliation: Department of Radiology, University Hospital of Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
authors.forename: K W
authors.initials: KW
authors.lastname: Stock
authors.forename: A L
authors.initials: AL
authors.lastname: Jacob
authors.forename: K J
authors.initials: KJ
authors.lastname: Schnabel
authors.forename: G
authors.initials: G
authors.lastname: Bongartz
authors.forename: W
authors.initials: W
authors.lastname: Steinbrich
mesh_terms: D015901:Angiography, Digital Subtraction; D002404:Catheterization; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000628:therapy*; D015641:Radiography, Interventional; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator