title: Successful pharmacomechanical intervention with ultrasonic-accelerated thrombolytic catheter for massive pulmonary embolism.
abstract: An 86-year-old male with history of metastatic prostate carcinoma and hypertension was admitted due to acute onset dyspnea and lower extremity pain and swelling. Transthoracic echocardiography revealed a large right atrial thrombus extending in to the right ventricle. Within 12 h, the patient developed severe hypoxemia, tachypnea with sustained hypotension and cardiogenic shock due to presumed massive pulmonary embolism. The patient underwent emergency pulmonary angiography which showed large emboli in the right main pulmonary artery extending in to the middle and lower lobe branches. An ultrasonic-accelerated thrombolytic catheter was placed in the right main pulmonary artery for continuous infusion of alteplase for 20 h. Repeat pulmonary angiogram showed resolution of the large pulmonary emboli, with normal flow in to the distal pulmonary arteries. Significant improvement of hemodynamics, symptoms and hypoxemia occurred as well.
authors.affiliation: Department of Internal Medicine, Division of Hospital Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA. Electronic address: mateo.porres@ttuhsc.edu.
authors.forename: Mateo
authors.initials: M
authors.lastname: Porres-Aguilar
authors.affiliation: Department of Internal Medicine, Division of Hospital Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: Jose D
authors.initials: JD
authors.lastname: Burgos
authors.affiliation: Division of Cardiology, Del Sol Medical Center, El Paso, TX, USA.
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Munoz
authors.affiliation: Division of Cardiology, Del Sol Medical Center, El Paso, TX, USA.
authors.forename: Ediberto
authors.initials: E
authors.lastname: Soto-Cora
authors.affiliation: Department of Medicine, Chair, Division of Cardiovascular Diseases, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX, USA.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D002404:Catheterization / Q000379:methods; D003131:Combined Modality Therapy; D004630:Emergencies; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D014463:Ultrasonography; D014654:Vascular Patency / Q000187:drug effects / Q000502:physiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Endovascular techniques; Massive pulmonary embolism; Pharmacomechanical thrombolysis; Ultrasonic-accelerated catheter-directed thrombolysis; Venous thromboembolism