title: Mechanical breakdown and thrombolysis in subacute massive pulmonary embolism: A prospective trial.
abstract: OBJECTIVE
  To assess role of combined modality of mechanical fragmentation and intralesional thrombolysis in patients with massive pulmonary embolism presenting subacutely.
  
  
  METHODS
  Eight of 70 patients presenting in tertiary care centre of North India with massive pulmonary embolism within 4 years had subacute presentation (symptom onset more than 2 wk). These patients were subjected to pulmonary angiography with intention to treat basis via mechanical breakdown and intra lesional thrombolysis. Mechanical breakdown of embolus was accomplished with 5-F multipurpose catheter to re-establish flow, followed by intralesional infusion of urokinase (4400 IU/kg over 10 min followed by 4400 IU/kg per hour over 24 h).
  
  
  RESULTS
  Eight patients, mean age 47.77 ± 12.20 years presented with subacute pulmonary embolism (mean duration of symptoms 2.4 wk). At presentation, mean heart rate, shock index, miller score and mean pulmonary pressures were 101.5 ± 15.2/min, 0.995 ± 0.156, 23.87 ± 3.76 and 37.62 ± 6.67 mmHg which reduced to 91.5 ± 12.2/min (P = 0.0325), 0.789 ± 0.139 (P = 0.0019), 5.87 ± 1.73 (P = 0.0000004) and 27.75 ± 8.66 mmHg (P = 0.0003) post procedurally. Mean BP improved from 80.00 ± 3.09 mmHg to 90.58 ± 9.13 mmHg (P = 0.0100) post procedurally. Minor complications in the form of local hematoma-minor hematoma in 1 (12.5%), and pseudoaneurysm (due to femoral artery puncture) in 1 (12.5 %) patient were seen. At 30 d and 6 mo follow up survival rate was 100% and all the patients were asymptomatic and in New York Heart Association class 1.
  
  
  CONCLUSIONS
  Combined modality of mechanical fragmentation and intralesional thrombolysis appears to be a promising alternative to high risk surgical procedures in patients with subacute massive pulmonary embolism.
authors.affiliation: Bishav Mohan, Shibba Takkar Chhabra, Naved Aslam, Gurpreet Singh Wander, Naresh Kumar Sood, Department of Cardiology, Dayanand Medical College and Hospital, Unit Hero DMC Heart Institute, Ludhiana141001, Punjab, India.
authors.forename: Bishav
authors.initials: B
authors.lastname: Mohan
authors.forename: Shibba Takkar
authors.initials: ST
authors.lastname: Chhabra
authors.forename: Naved
authors.initials: N
authors.lastname: Aslam
authors.forename: Gurpreet Singh
authors.initials: GS
authors.lastname: Wander
authors.forename: Naresh Kumar
authors.initials: NK
authors.lastname: Sood
authors.forename: Sumati
authors.initials: S
authors.lastname: Verma
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Mehra
authors.forename: Sarit
authors.initials: S
authors.lastname: Sharma
keywords: Catheter directed; Intra pulmonary; Mechanical breakdown; Subacute; Thromboembolic; Thrombolysis