title: Thrombolysis and mechanical fragmentation to treat massive pulmonary embolism in a patient with an anterior communicating artery aneurysm.
abstract: OBJECTIVE
  To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm.
  
  
  METHODS
  An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated.
  
  
  CONCLUSIONS
  Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.
authors.affiliation: Department of Radiology, Inonu University School of Medicine, Malatya, Turkey. rkutlu@inonu.edu.tr
authors.forename: Ramazan
authors.initials: R
authors.lastname: Kutlu
authors.forename: Alpay
authors.initials: A
authors.lastname: Alkan
authors.forename: Ayhan
authors.initials: A
authors.lastname: Kocak
authors.forename: Kaya
authors.initials: K
authors.lastname: Sarac
mesh_terms: D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000628:therapy*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology* / Q000628:therapy*; D015912:Thrombolytic Therapy