[Mechanical fragmentation and intrapulmonary fibrinolysis in the treatment of massive pulmonary embolism hemodynamic repercussions].
OBJECTIVE
To evaluate the efficacy and safety of mechanical fragmentation associated with intrapulmonary thrombolysis to treat massive pulmonary thromboembolism (PTE) with altered hemodynamics.


METHODS
Fifty-one patients with a diagnosis of acute PTE were enrolled, the criteria being a Miller index over 0.50 and mean pressure of 30 mmHg in the principal superior pulmonary artery. The initial clinical pictures included shock (19 patients), syncope (6) and severe dyspnea at rest (26). Oxygen saturation measured by pulse oxymetry was 71.4%. Mean pulmonary artery pressure was 46.1 mmHg. The main thromboembolisms were fragmented, with one bolus of a fibrinolytic agent administered during the fragmentation procedure. An infusion of the fibrinolytic agent was administered through a catheter. Monitoring included clinical assessment, pulmonary scintigraphy and echocardiography.


RESULTS
After fragmentation and administration of the bolus dose of the fibrinolytic agent, improvement was observed in 49 patients (97.2%). Mean pressure after mechanical and pharmacological treatment was 24.1 mmHg. Technical success was achieved in 100% of the patients.


CONCLUSIONS
The results attest to the efficacy and safety of mechanical fragmentation and medical thrombolysis in treating massive PTE affecting hemodynamics, leading to clinical improvement and lowered pulmonary artery pressure.
de Gregorio
M
M
Unidad de Radiología Intervencionista. Hospital Clínico Universitario. Zaragoza.
Gimeno
M
M
Alfonso
R
R
Medrano
J
J
Loyola
S
S
Fava
M
M
Herrera
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*