title: Massive and submassive pulmonary embolism: experience with an algorithm for catheter-directed mechanical thrombectomy.
abstract: BACKGROUND
  The role of catheter-directed mechanical thrombectomy (CDMT) for the treatment of massive pulmonary embolism (MPE) and submassive pulmonary embolism (SMPE) is not clearly defined. We report our experience with an algorithm for CDMT as a primary treatment in patients with MPE and SMPE.
  
  
  METHODS
  We retrospectively reviewed our experience in treating MPE and SMPE in consecutive patients over a 2-year period (2008-2010). Patients with computed tomography angiography evidence of saddle, main branch, or ≥2 lobar pulmonary emboli in the setting of hypoxia, tachycardia, echocardiographic right heart strain, and/or cardiogenic shock underwent AngioJet CDMT, with or without adjunctive thrombolytic power-pulse spray. Outcomes, including angiographic success, clinical improvement, complications, and survival to discharge, were evaluated.
  
  
  RESULTS
  Fifteen patients (8 men, 7 women; 14 SMPE, 1 SMPE) with a mean age of 59 years (range: 35-90 years) were treated for heart strain (100%), tachycardia (67%), hypoxia (67%), and cardiogenic shock (7%). Ten patients (67%) also received Alteplase power-pulse spray. Resolution of symptoms and improvement in heart strain were achieved in all patients. There were no in-hospital mortalities. Complications occurred in 3 patients (20%), including 2 patients with acute tubular necrosis and 1 patient with an intraoperative cardiac arrest. Average hospitalization was 9 days (range: 4-26 days). All patients were discharged on full anticoagulation. None required supplemental oxygen at discharge.
  
  
  CONCLUSIONS
  CDMT as primary treatment of MPE and SMPE has a high rate of technical and clinical success in a high-risk patient population. Experience and strict patient selection criteria may improve therapeutic outcomes.
authors: Department of Surgery, Division of Vascular & Endovascular Surgery, The Heart & Vascular Institute of New York, Lenox Hill Hospital, New York, NY 10075, USA. naiemn@gmail.com
authors: Naiem
authors: N
authors: Nassiri
authors: Amit
authors: A
authors: Jain
authors: Diana
authors: D
authors: McPhee
authors: Bushra
authors: B
authors: Mina
authors: Robert J
authors: RJ
authors: Rosen
authors: Gary
authors: G
authors: Giangola
authors: Alfio
authors: A
authors: Carroccio
authors: Richard M
authors: RM
authors: Green
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography; D057785:Catheters; D004452:Echocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome