[Treatment of massive pulmonary embolism with local thrombolysis].
BACKGROUND
The diagnosis and therapy of pulmonary embolism may still be difficult. Patients with massive central emboli have an unacceptable risk of treatment failure and death when treated with conventional anticoagulants.


RESULTS
Three patients with massive pulmonary embolism were treated with local catheter-directed thrombolysis and mechanical fragmentation. Nearly total thrombolysis was achieved, as estimated by angiography and spiral CT scan. Clinical improvement was confirmed by blood gas measurements, pulse oximetry, and echocardiographic assessment.


CONCLUSIONS
Based on data from the literature, thrombolytic therapy is more efficient than conventional anticoagulation in patients with massive central pulmonary embolism affecting the systemic circulation. Local, catheter-directed thrombolysis with mechanical fragmentation and direct infusion into the thrombus produced very good results in our patients. Other published data confirm that this method is feasible, safe and effective. In selected patients, this therapy is a good alternative to systemic thrombolysis, although it remains to be established which method is best.
Egge
Jon
J
Radiologisk avdeling, Haugesund sjukehus 5513 Haugesund. jon.egge@fih.rfk-helse.telemax.no
Berentsen
Sigbjørn
S
Storesund
Bertha
B
Rød
Reinert
R
Waage
Kjell
K
D000328:Adult; D002407:Catheterization, Swan-Ganz / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010960:Plasminogen Activators / Q000008:administration & dosage; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011877:Radionuclide Imaging; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010960:Plasminogen Activators