Efficacy and Safety of Flow-Directed Pulmonary Artery Catheter Thrombolysis for Treatment of Submassive Pulmonary Embolism

2014 ◽  
Vol 202 (6) ◽  
pp. 1355-1360 ◽  
Author(s):  
Ron C. Gaba ◽  
Madhu S. Gundavaram ◽  
Ahmad Parvinian ◽  
M. Grace Knuttinen ◽  
Jeet Minocha ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Efficacy And Safety ◽  
Submassive Pulmonary Embolism ◽  
Catheter Thrombolysis

scholarly journals Clinical outcomes of submassive pulmonary embolism thrombolysis—an Indian experience

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Nadeem U. Rehman ◽  
Mohd Iqbal Dar ◽  
Manish Bansal ◽  
R. R. Kasliwal
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Systolic Dysfunction ◽  
Massive Pulmonary Embolism ◽  
Post Treatment ◽  
Control Group ◽  
Submassive Pulmonary Embolism ◽  
Venous Thromboembolic ◽  
Pre Treatment ◽  
And Control

Abstract Background Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboembolic disease. The role of thrombolysis in massive pulmonary embolism has been studied extensively, but the same is not there for submassive pulmonary embolism. This study is aimed at evaluating the effects of thrombolysis in acute submassive pulmonary embolism. This was a prospective, case-control, observational study. Patients presenting with acute submassive pulmonary embolism were divided into thrombolysis group and control group depending on whether they received thrombolysis plus anticoagulation or anticoagulation only, respectively. Results A total of 86 patients were included in the study. Forty-two patients were in the thrombolysis group, and 44 patients were in the control group. The mean ± SD age in the control and thrombolysis groups was 63.3 ± 14.7 and 56.4 ± 13.8 years, respectively. The two groups were well matched in sex distribution and associated comorbidities like COPD, active surgery, major trauma, and immobilization. On echocardiography, dilated RA/RV in pre-treatment vs. post-treatment was seen in 20 (45.5%) vs. 20 (45.5%) in the control group and 26 (61.9%) vs. 11 (26.2%) in the thrombolysis group. Similarly, RV systolic dysfunction in pre-treatment vs. post-treatment was seen in 24 (54.5%) vs. 21 (47.7%) in the control group and 22 (52.4%) vs. 8 (19.0%) in the thrombolysis group. Pulmonary artery pressure in pre-treatment vs. post-treatment was 64.4 ± 15.0 vs. 45.9 ± 9.9 mmHg in the control group and 68.3 ± 17.4 vs. 31.4 ± 6.9 mmHg in the thrombolysis group. In control vs. thrombolysis group, there were 5 vs. 1 death, 6 vs. 1 hemodynamic decompensation, and 6 vs. 1 patient needing mechanical ventilation. Conclusion Thrombolysis in submassive pulmonary embolism is associated with better right ventricular functions, lower pulmonary artery pressures, and comparable mortality rates.

Efficacy and Safety of Low-Dose Systemic Fibrinolytic Therapy for Acute Submassive Pulmonary Embolism

2021 ◽  
Vol 14 (7) ◽  
pp. 809
Author(s):  
Ahmet Güner ◽  
Ezgi Gültekin Güner ◽  
Seda Karakurt ◽  
Macit Kalçık
Keyword(s):  
Pulmonary Embolism ◽  
Low Dose ◽  
Fibrinolytic Therapy ◽  
Efficacy And Safety ◽  
Submassive Pulmonary Embolism

scholarly journals Successful treatment of massive pulmonary embolism using a pulmonary artery catheter during prolonged normothermic cardiopulmonary resuscitation

2014 ◽  
Vol 13 (3) ◽  
pp. 118-120
Author(s):  
Elisabeth Dovern ◽  
◽  
Marlene R. Mende ◽  
Niels J Elderson ◽  
Eelko Ronner ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiopulmonary Resuscitation ◽  
Pulmonary Artery ◽  
Pulmonary Artery Catheter ◽  
Treatment Options ◽  
Tertiary Care ◽  
Massive Pulmonary Embolism ◽  
Neurological Recovery ◽  
Successful Outcome ◽  
Systemic Thrombolysis

Massive pulmonary embolism has a high mortality rate. Standard treatment includes systemic thrombolysis. If this fails, surgical embolectomy or a percutaneous catheter-guided approach is advised in current guidelines. However, these treatment options might not be available in many non-tertiary care hospitals. We describe a case of a 25-year old woman with cardiac arrest from massive pulmonary embolism. She was treated with thrombus fragmentation using a pulmonary artery catheter and intra-pulmonary thrombolysis after failure of systemic thrombolysis along with 90 minutes of cardiopulmonary resuscitation (CPR). Neurological recovery was excellent and pulmonary pressure was normalized after one month. Besides catheter guided thrombus fragmentation and thrombolysis, we contribute the successful outcome to a combination of ultrasound-guided therapy, capnography-guided CPR, and “crew resource management” principles. Our case illustrates that a pulmonary artery catheter can be used successfully in a non-tertiary setting, to perform a percutaneous procedure during CPR and that full neurological recovery is possible after 90 minutes of CPR.

Large-bore Aspiration Thrombectomy for Acute Venous Thromboembolism

2021 ◽  
Vol 39 ◽  
Author(s):  
Andy Sohn ◽  
◽  
James Hu ◽  
Jennifer Colnick ◽  
Justin George ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Short Term ◽  
Aspiration Thrombectomy ◽  
Acute Setting ◽  
Submassive Pulmonary Embolism ◽  
Thromboembolic Pulmonary Hypertension ◽  
Acute Venous Thromboembolism

Pulmonary embolism can occur following dislodgement of deep venous thrombosis into the pulmonary artery circulation, which results in obstruction of the pulmonary artery system and can be fatal. The consequences of pulmonary embolism include hypotension, right heart strain, and hypoxia. In the long term, pulmonary embolism may lead to Chronic Thromboembolic Pulmonary Hypertension (CTEPH). Patients who develop hypotensive massive and submassive pulmonary embolism can be treated with large-bore aspiration thrombectomy. In the acute setting, this improves short-term outcomes by decreasing the ICU stay. It can also reduce the risk of CTEPH. Options for large-bore aspiration thrombectomy include the FlowTriever™ system (Inari Medical, Irvine, CA) and the Lightning 12 vascular thrombectomy system (Penumbra Inc., Alameda, CA). This review discusses the pathophysiology of pulmonary embolism, management, and options for large-bore aspiration thrombectomy.

A retrospective review of patients with massive and submassive pulmonary embolism treated with AngioJet rheolytic thrombectomy with decreased complications due to changes in thrombolytic use and procedural modifications

Vascular ◽  
2017 ◽  
Vol 26 (2) ◽  
pp. 163-168 ◽  
Author(s):  
Sundeep Das ◽  
Nikhil Das ◽  
Harvey Serota ◽  
Sriram Vissa
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Retrospective Review ◽  
Bleeding Complications ◽  
Submassive Pulmonary Embolism ◽  
Short Run ◽  
Rheolytic Thrombectomy ◽  
Procedural Modification

Objectives A retrospective review of treatment of patients with massive or submassive pulmonary embolism (PE) using AngioJet rheolytic thrombectomy (ART) system with procedural modifications to improve on the previously reported outcomes. Materials and Methods Thirteen patients underwent emergent pulmonary artery thrombectomy for massive and submassive PE using ART with pharmacological and procedural modification, in comparison to prior reports. The modifications included the selective use of the Solent Omni AngioJet device in all subjects, distal contrast angiography via the AngioJet catheter before device activation, and limited short run times. Thrombolytic therapy was not used in any patient. Patients were monitored for short- and long-term outcomes. Long-term clinical follow-up and evaluation for persistent pulmonary hypertension with echocardiography was performed. Results The pharmacological and procedural modifications resulted in a favorable clinical response without any major complications and without any mortality. Procedure-related anemia (mean hemoglobin drop of 0.49 g/dl) was the only significant minor complication noted. There were no bleeding complications and no transfusion requirement. On a six-month follow-up, there was no mortality, and there were significant reductions in the pulmonary artery pressures. Conclusion Major and minor complications were reduced compared to prior reports using ART. A modified ART approach towards treatment of high-risk PE appears promising both in terms of efficacy and safety.

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