Hybrid treatment of acute massive pulmonary thromboembolism: mechanical fragmentation with a modified rotating pigtail catheter, local fibrinolytic therapy, and clot aspiration followed by systemic fibrinolytic therapy.
OBJECTIVE
We sought to evaluate the efficacy and safety of a hybrid treatment for acute massive pulmonary thromboembolism in patients with hemodynamic impairment by combining mechanical fragmentation, local thrombolysis, and clot aspiration.


METHODS
Within a period of 35 months, 25 patients with hemodynamic impairment (eight men and 17 women; age range, 35-77 years) were treated with mechanical thrombus fragmentation using a modified rotating pigtail catheter. After embolus fragmentation, all patients received an intrapulmonary injection of recombinant human-tissue plasminogen activator and then underwent manual clot aspiration with a large-lumen percutaneous transluminal coronary angioplasty guide catheter.


RESULTS
All the patients survived, and their clinical status improved. Posttreatment angiography showed an improvement in pulmonary perfusion in all patients (mean Miller score before treatment, 22.2; after treatment, 13.6; p < 0.01). Mean pulmonary artery pressure decreased from 32.6 to 23.4 mm Hg (p < 0.01). Mean treatment time was 124.6 min.


CONCLUSIONS
Hybrid treatment with mechanical fragmentation using a rotating pigtail catheter combined with local fibrinolysis and manual clot aspiration resulted in a rapid and safe improvement in the hemodynamic condition of patients with acute massive pulmonary thromboembolism. This hybrid treatment appears to be especially useful in patients at high risk for right ventricular failure and is a minimally invasive alternative to surgical embolectomy.
Tajima
Hiroyuki
H
Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8601, Japan. h-tajima@nms.ac.jp
Murata
Satoru
S
Kumazaki
Tatsuo
T
Nakazawa
Ken
K
Abe
Yutaka
Y
Komada
Yasushige
Y
Niggemann
Pascal
P
Takayama
Morimasa
M
Tanaka
Keiji
K
Takano
Teruo
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002404:Catheterization; D003131:Combined Modality Therapy; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000628:therapy*; D013396:Suction; D015912:Thrombolytic Therapy / Q000379:methods