Rheolytic thrombectomy in patients with massive and submassive acute pulmonary embolism.
OBJECTIVE
To appraise the impact of AngioJet rheolytic thrombectomy (RT) on angiographic and clinical endpoints in patients with acute pulmonary embolism (PE).


BACKGROUND
The management of patients with acute PE and hemodynamic compromise, based mainly on anticoagulant and thrombolytic therapies, is challenging and still suboptimal in many patients. In such a setting, mechanical removal of thrombus from pulmonary circulation holds the promise of significant clinical benefits, albeit remains under debate.


METHODS
We retrospectively report on 51 patients referred to our catheterization laboratory and treated with AngioJet RT. Patients were classified according to the degree of hemodynamic compromise (shock, hypotension, and right ventricular dysfunction) to explore thoroughly the degree of angiographic pulmonary involvement (angiographic massive PE was defined as the presence of a Miller index >or= 17) and the impact on angiographic (obstruction, perfusion, and Miller indexes) and clinical (all-cause death, recurrence of PE, bleeding, renal failure, and severe thrombocytopenia) endpoints of AngioJet RT.


RESULTS
Angiographic massive PE was present in all patients with shock, whereas patients with right ventricular dysfunction and hypotension showed a similar substantial pulmonary vascular bed involvement. Technical success was obtained in 92.2% of patients, with a significant improvement in obstruction, perfusion and Miller indexes in each subgroup (all P < 0.0001). Four patients reported major bleedings and eight (15.7%) died in-hospital. Laboratory experience was significantly associated to a lower rate of major bleedings. All survivors were alive at long-term follow-up (35.5 +/- 21.7 months) except three who expired due to cancer and acute myocardial infarction.


CONCLUSIONS
In experienced hands AngioJet RT can be operated safely and effectively in most patients with acute PE, either massive or submassive, and substantial involvement of pulmonary vascular bed.
Chechi
Tania
T
Division of Cardiology, Cardiologia e Cardiologia Invasiva 2, A.O.U. Careggi, Florence, Italy.
Vecchio
Sabine
S
Spaziani
Gaia
G
Giuliani
Gabriele
G
Giannotti
Federica
F
Arcangeli
Chiara
C
Rubboli
Andrea
A
Margheri
Massimo
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D018056:Hemorheology; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012769:Shock / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery