scholarly journals Endovascular management of massive pulmonary embolism with clot fragmentation and suction

2013 ◽  
Vol 12 (1) ◽  
pp. 49-52
Author(s):  
Sergio Quilici Belczak ◽  
Igor Rafael Sincos ◽  
Ricardo Aun ◽  
Alex Lederman ◽  
Boulanger Mioto Neto ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Imaging Study ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism ◽  
Sudden Onset ◽  
Percutaneous Mechanical Thrombectomy ◽  
Limb Edema ◽  
To Receive

Massive pulmonary embolism with right ventricular dysfunction may be treated with thrombolysis, embolectomy, or percutaneous mechanical thrombectomy. This study describes our experience with two patients that had massive pulmonary embolism and were treated with percutaneous mechanical thrombectomy and reports on the mid-term results of this procedure. A 28-year-old man and a 70-year-old woman were diagnosed with deep venous thrombosis and massive pulmonary embolism. They first had lower limb edema followed by sudden onset of dyspnea. Their physical examination revealed edema, tachypnea, chest discomfort and jugular turgescence. Both needed to receive oxygen using a nasal cannula. Doppler ultrasound, echocardiography, and computed tomography angiography were used to establish the diagnoses. Patients underwent percutaneous mechanical thrombectomy using the Aspirex® system (Straub Medical), and their clinical condition and imaging study findings improved substantially. At mid-term follow-up, patient conditions were improving satisfactorily.

scholarly journals MASSIVE PULMONARY EMBOLISM TREATED WITH PERCUTANEOUS MECHANICAL THROMBECTOMY

2021 ◽  
Vol 77 (18) ◽  
pp. 2803
Author(s):  
Radhika Deshpande ◽  
Basma Al-Bast ◽  
Mukul Bhattarai ◽  
Abhishek Kulkarni ◽  
Prashant Jagtap
Keyword(s):  
Pulmonary Embolism ◽  
Mechanical Thrombectomy ◽  
Massive Pulmonary Embolism ◽  
Percutaneous Mechanical Thrombectomy

scholarly journals Case of a floating right atrial thrombus successfully treated with fibrinolysis

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Chloé Bernard ◽  
Olivier Bouchot ◽  
Marjolaine Georges ◽  
Marie Catherine Morgant
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Anticoagulation Therapy ◽  
Right Ventricular Dysfunction ◽  
Blood Gases ◽  
Good Alternative ◽  
Massive Pulmonary Embolism ◽  
Medical Emergency ◽  
Right Atrial

Mobile right atrial thrombi are at high risk of causing massive pulmonary embolism and are a medical emergency. This type of thrombus is identified in about 4-18% of pulmonary embolism cases. The presence of a free-floating embolic mass in right atrial or ventricle is often mortal: the death rate can reach 27%. Although surgery is commonly indicated, fibrinolysis is a therapeutic alternative. Here, a 58-year-old man presented to the emergency department for acute dyspnea associated with a painful right leg. Initial exams showed a shunt effect on blood gases with increased brain natriuretic peptide. Transthoracic echography (TTE) found a free-floating thrombus in the right atrium with signs of pulmonary hypertension and right ventricular dysfunction. Bilateral pulmonary embolism was confirmed by computed tomography angiography. Because there were signs of acute cor pulmonale and no contraindications, treatment with systemic fibrinolysis was decided. The treatment was delivered in intensive care unit and a cardiac surgical team was available. Subsequent clinical improvement was observed. TTE follow up at 12 hours revealed complete thrombus dissolution. There were no complications, in particular no hemorrhage. The patient was discharged after eleven days. At 6 months of follow-up, outcomes with oral anticoagulation therapy were satisfactory. Scintigraphy found good symmetrical perfusion of both lungs with stackable ventilation. TTE at 1 year showed preserved left and right ventricular function with no sign of pulmonary arterial hypertension and no thrombus recurrence. Systemic fibrinolysis appears to be a good alternative to surgery in this case.

scholarly journals Safety of the Inari FlowTriever device for mechanical thrombectomy in patients with acute submassive and massive pulmonary embolism and contraindication to thrombolysis

2020 ◽  
Vol 4 ◽  
pp. 18
Author(s):  
Michael Markovitz ◽  
Nicholas Lambert ◽  
Lowell Dawson ◽  
Glenn Hoots
Keyword(s):  
Heart Rate ◽  
Pulmonary Embolism ◽  
Oxygen Saturation ◽  
Mechanical Thrombectomy ◽  
Clinical Success ◽  
Retrospective Chart Review ◽  
Massive Pulmonary Embolism ◽  
Percutaneous Mechanical Thrombectomy ◽  
Submassive Pulmonary Embolism ◽  
Anticoagulated Patients

Objectives: This report evaluates the safety of percutaneous mechanical thrombectomy with the Inari FlowTriever System (Inari Medical, Irvine, California) for the treatment of acute massive/submassive pulmonary embolism (PE) specifically in therapeutically anticoagulated patients with contraindication to thrombolysis. Material and Methods: A single-center retrospective chart review was performed on patients with contraindication to thrombolysis and massive/submassive PE who underwent FlowTriever thrombectomy between 2017 and 2019. Primary outcomes included procedure or device-related complications within 30 days of discharge. Secondary outcomes included technical and clinical success defined by improvement in mean pulmonary artery pressure (PAP), oxygen saturation, and heart rate. Results: Thirteen patients with contraindication to thrombolysis received FlowTriever thrombectomy with technical success achieved in all cases. Zero major or minor adverse events, technical complications, delayed procedure-related complications, or deaths within 30 days of hospital discharge occurred. Mean PAP decreased significantly by 19.1% (32.5 ± 13.3 mmHg to 26.3 ± 12.4 mmHg; P = 0.0074, 95% confidence interval (CI) 2.0–10.5 mmHg). Oxygen saturation improved post-procedure (increased 3.9 ± 3.8%; p = 0.0032, 95% CI 1.6– 6.1%) as did heart rate (decreased 22.2 ± 17.0 bpm; P < 0.001, 95% CI 11.9–32.4 bpm). Anticoagulation was maintained throughout every procedure and all patients were closed with purse-string suture only. Conclusion: FlowTriever mechanical thrombectomy appears safe for acute PE in therapeutically anticoagulated patients with contraindications to thrombolytic therapy. These patients may experience immediate hemodynamic improvements similar to those reported in other studies. Further data are needed to prospectively evaluate long-term safety in this population.

scholarly journals Percutaneous thrombectomy and right ventricular mechanical circulatory support for pulmonary embolism in a COVID-19 patient: Case report, one-year update, and echocardiographic findings

2022 ◽  
Author(s):  
Gerald I Cohen ◽  
Theodore Schreiber ◽  
Hemindermeet Singh ◽  
Amir Kaki
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Massive Pulmonary Embolism ◽  
Circulatory Support ◽  
Medical Systems ◽  
One Year ◽  
Percutaneous Thrombectomy

Abstract Background We previously described percutaneous thrombectomy and right ventricular mechanical support of a COVID-19 patient with a massive pulmonary embolism. Here we present a detailed echocardiographic and clinical timeline with 1 year follow-up. Case Summary A 57-year-old female with COVID-19 went into shock from a massive pulmonary embolism. After percutaneous removal of a large thrombus burden (AngioVac system; AngioDynamics Inc, Latham, NY, USA), she became severely hypotensive, requiring CPR, and was resuscitated with an Impella RP device (Abiomed, Danvers, MA, USA). A pediatric TEE probe monitored the procedure because an adult probe would not pass (S7-3t—Philips Medical Systems, Andover, MA, USA). Post thrombectomy, surface imaging documented gradual resolution of right ventricular dysfunction, tricuspid regurgitation, and elevated pulmonary artery pressure. Her course was complicated by renal failure requiring temporary dialysis. She was discharged home on apixaban. Hypercoagulability work-up was negative. Two months later, vocal cord surgery was performed for persistent stridor. Esophagoscopy at that time was prevented by osteophyte obstruction. At 10 months, she received the Pfizer-BioNTech vaccine. At one year, the patient remains healthy on apixaban, and her echocardiogram is normal. Discussion This case illustrates the pivotal role of echocardiography in the diagnosis, percutaneous treatment, and near- and long-term follow-up and management of a patient with massive pulmonary embolism due to COVID-19 with documentation of complete recovery from severe right ventricular dysfunction and hemodynamic collapse. A pediatric TEE probe was a crucial alternative to the adult probe because of possible osteophyte obstruction.

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