title: Impact of catheter fragmentation followed by local intrapulmonary thrombolysis in acute high risk pulmonary embolism as primary therapy.
abstract: BACKGROUND
  Pulmonary embolism (PE) with more than 50% compromise of pulmonary circulation results significant right ventricular (RV) afterload leading to progressive RV failure, systemic hypotension and shock. Prompt restoration of thrombolysis, surgical embolectomy, or percutaneous mechanical thrombectomy (PMT) prevents progressive hemodynamic decline. We report our single center experience in high risk PE patients treated with standard pigtail catheter mechanical fragmentation followed by intrapulmonary thrombolysis as a primary therapy.
  
  
  METHODS
  50 consecutive patients with diagnosis of high risk PE defined as having shock index >1 with angiographic evidence of >50% pulmonary arterial occlusion are included in the present study. All patients underwent emergent cardiac catheterization. After ensuring flow across pulmonary artery with mechanical breakdown of embolus by rotating 5F pigtail catheter; bolus dose of urokinase (4400 IU/kg) followed by infusion for 24 h was given in the thrombus. Hemodynamic parameters were recorded and follow up pulmonary angiogram was done. Clinical and echo follow up was done for one year.
  
  
  RESULTS
  Pigtail rotational mechanical thrombectomy restored antegrade flow in all patients. The mean pulmonary artery pressure, Miller score, Shock index decreased significantly from 41 ± 8 mmHg, 20 ± 5, 1.32 ± 0.3 to 24.52 ± 6.89, 5.35 ± 2.16, 0.79 ± 0.21 respectively (p < 0.0001). In-hospital major complications were seen in 4 patients. There was a statistically significant reduction of PA pressures from 62 ± 11 mmHg to 23±6 mmHg on follow up.
  
  
  CONCLUSIONS
  Rapid reperfusion of pulmonary arteries with mechanical fragmentation by pigtail catheter followed by intrapulmonary thrombolysis results in excellent immediate and intermediate term outcomes in patients presenting with high risk pulmonary embolism.
authors: Department of Cardiology, Dayanand Medical College & Hospital Unit Hero DMC Heart Institute, Ludhiana 141001, Punjab, India. Electronic address: bishavmohan68@gmail.com.
authors: Bishav
authors: B
authors: Mohan
authors: Department of Cardiology, Dayanand Medical College & Hospital Unit Hero DMC Heart Institute, Ludhiana 141001, Punjab, India.
authors: Naved
authors: N
authors: Aslam
authors: Department of Medicine, Keck School of Medicine, LAC-USC Medical Center, 1200 North State Street, Los Angeles, CA 90033, USA.
authors: Anil
authors: A
authors: Kumar Mehra
authors: Department of Cardiology, Dayanand Medical College & Hospital Unit Hero DMC Heart Institute, Ludhiana 141001, Punjab, India.
authors: Shibba
authors: S
authors: Takkar Chhabra
authors: Department of Cardiology, Dayanand Medical College & Hospital Unit Hero DMC Heart Institute, Ludhiana 141001, Punjab, India.
authors: Praneet
authors: P
authors: Wander
authors: Department of Cardiology, Dayanand Medical College & Hospital Unit Hero DMC Heart Institute, Ludhiana 141001, Punjab, India.
authors: Rohit
authors: R
authors: Tandon
authors: Department of Cardiology, Dayanand Medical College & Hospital Unit Hero DMC Heart Institute, Ludhiana 141001, Punjab, India.
authors: Gurpreet
authors: G
authors: Singh Wander
mesh_terms: D000208:Acute Disease; D000368:Aged; D000792:Angiography; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000628:therapy*; D017131:Thrombectomy / Q000295:instrumentation*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Catheter fragmentation; Intrapulmonary; Pulmonary embolism; Thrombolysis