title: [Percutaneous rheolytic thrombectomy with AngioJet for pulmonary embolism: methods and results in the experience of a high-volume center].
abstract: BACKGROUND
  Pulmonary embolism is a common disease with significant mortality. Anticoagulant and thrombolytic therapies are a mainstay in the management of acute pulmonary embolism, especially with hemodynamic compromise. However, systemic drugs cannot achieve timely and effective treatment of acute pulmonary embolism in all patients. Recently, rheolytic thrombectomy has been proven to be effective in the treatment of massive thrombosis in vein grafts. The purpose of this study was to describe the rheolytic thrombectomy procedure and to evaluate the efficacy of thrombus removal using the AngioJet catheter in patients with acute massive and submassive pulmonary embolism.
  
  
  METHODS
  Thirty consecutive patients (16 men, 14 women, mean age 67.9 +/- 13.5 years) with massive or submassive pulmonary embolism were treated with rheolytic thrombectomy. The Miller index and the systolic pulmonary pressure were evaluated pre- and post-rheolytic thrombectomy. In-hospital results were analyzed according to the learning curve of operators.
  
  
  RESULTS
  Technical success was achieved in 93.3% of patients. Eleven patients received adjunctive loco-regional thrombolytic agent (alteplase) or abciximab. A significant improvement in the obstruction, perfusion and Miller indexes and in the systolic pulmonary pressure was observed after rheolytic thrombectomy (p <0.0001) in all patients. The achievement of a larger experience by the operators was associated with a less procedural complication rate (i.e. post-procedural increase in creatinine, cardiac arrest during the procedure, post-procedural hemoptysis, and in-hospital mortality). Total in-hospital mortality occurred in 5 patients (16.7%), 60% of them presented with cardiogenic shock. All patients were alive at the 12-month follow-up, except one who died after 3 months for myocardial infarction.
  
  
  CONCLUSIONS
  Percutaneous rheolytic thrombectomy using the AngioJet catheter may be a valid treatment option for patients with massive or submassive pulmonary embolism with rapid and significant hemodynamic improvement and encouraging results at early and long-term follow-up. Greater laboratory and operator experience yield better clinical results.
authors.affiliation: Cardiologia e Cardiologia Invasiva 2, AOU Careggi, Firenze. sabinevecchio@gmail.com
authors.forename: Sabine
authors.initials: S
authors.lastname: Vecchio
authors.forename: Guido
authors.initials: G
authors.lastname: Vittori
authors.forename: Tania
authors.initials: T
authors.lastname: Chechi
authors.forename: Gaia
authors.initials: G
authors.lastname: Spaziani
authors.forename: Alessio
authors.initials: A
authors.lastname: Lilli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Giuliani
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Consoli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
authors.forename: Massimo
authors.initials: M
authors.lastname: Margheri
mesh_terms: D000368:Aged; D002404:Catheterization; D005260:Female; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000601:surgery*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000379:methods*