Role of rheolytic thrombectomy in massive pulmonary embolism with contraindication to systemic thrombolytic therapy.
OBJECTIVE
Mortality of massive pulmonary embolism remains exceedingly high despite thrombolytic therapy. Despite initial encouraging results, rheolytic thrombectomy has not been considered the first choice of treatment in the current European Guidelines for massive pulmonary embolism, even in cases of major contraindication to thrombolysis. Our objective was to assess the efficacy of rheolytic thrombectomy in the specific treatment of massive pulmonary embolism with contraindication to systemic thrombolytic therapy.


RESULTS
Between January 2003 and April 2008 a total of 10 patients with massive pulmonary embolism referred for rheolytic thrombectomy were included. Clinical data including medical history, haemodynamic status, procedural characteristic, in-hospital complications and survival were collected. Seven patients survived after undergoing the procedure, three patients died in during their initial hospitalisation however, two of these deaths were not attributable to the pulmonary embolism or the procedure. Rheolytic thrombectomy resulted in reduction of mean pulmonary artery pressures from 34.6+/-13.1 mmHg to 26.9+/-8.2 mmHg immediately following the procedure. Additionally, the Miller index improved from 22.4+/-2.8 to 9.8+/-2.7. There were no periprocedural bleeding complications associated with the procedure.


CONCLUSIONS
Rheolytic thrombectomy might be an effective and safe treatment for massive pulmonary embolism when systemic thrombolytic therapy is contraindicated. These data form the basis for further clinical investigation of this novel therapy among patients with massive pulmonary embolism.
Arzamendi
Dabit
D
Montreal Heart Institute, Montreal, Canada. arzamend@clinic.ub.es
Bilodeau
Luc
L
Ibrahim
Reda
R
Noble
Stephane
S
Gallo
Richard
R
Lavoie-L'allier
Philippe
P
Gosselin
Gilbert
G
Deguise
Pierre
P
Ly
Hung
H
Tanguay
Jean-François
JF
Doucet
Serge
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000075202:Contraindications; D015150:Echocardiography, Doppler; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017131:Thrombectomy / Q000295:instrumentation*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D055815:Young Adult