A seven-year single-center experience on AngioJet rheolytic thrombectomy in patients with pulmonary embolism at high risk and intermediate-high risk

Abstract

Objective: AngioJet rheolytic thrombectomy (ART) has been used as a catheter-based treatment for acute pulmonary embolism (PE). In this study, based on our 7-year experience with ART in patients with PE, we evaluated the efficacy and safety outcomes of ART. Methods: Our study is based on retrospective evaluation of 56 patients with high-and intermediate-high-risk PE, with an average age of 62 years [interquartile range (IQR) 50-73 years] who underwent ART. Results: High and intermediate-high risks were noted in 21.4% and 78.6% of the patients, respectively. The ART duration was 304 (IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio, right to left atrial diameter ratio, and pulmonary arterial pressures were improved (p<0.001 for all). During the hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. Conclusion: ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, right ventricle strain, and hemodynamics in patients with PE at high and intermediate-high risk. Aging increased the risk of post-procedural nephropathy, whereas baseline high-risk status predicted in-hospital and long-term mortality.

Percutaneous treatment options for acute pulmonary embolism: a clinical consensus statement by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function and the European Association of Percutaneous Cardiovascular Interventions

“…Although postprocedural renal deterioration was observed in 39.3% of patients, 1-session dialysis was required in only 1 (1.8%) patient. These current data suggest that safety issues of rheolytic thrombectomy may be re-evaluated 33 .…”

Eosinophil-to-Monocyte Ratio as a Candidate for a Novel Prognostic Marker in Acute Pulmonary Embolism: Is it a Consumptive Mechanism?

“…The CT measures of RV/LVr, QS, PA diameters, and echocardiographic measures of TAPSE and pulmonary artery systolic pressure (PAPs) estimates were significantly improved after the reperfusion treatments including USAT, rheolytic thrombectomy, and IV tPA infusions ( Table 2 ). 11 - 14 …”

Case report: AngioJet thrombectomy with extracorporeal membrane oxygenation support for acute massive pulmonary embolism in a severe multiple trauma patient

“…The AngioJet System creates a local low-pressure zone to entrain, fragment, and aspirate thrombi via Bernoulli's principle of fluid dynamics. The largest and latest 7-year single-center study on AngioJet rheolytic thrombectomy in patients with PE revealed that for patients with PE who have various comorbidities and a proclivity to bleed, ART may be considered preferable, resulting in significant improvements in obstructive burden and hemodynamics (8). ART mentioned in most cases or articles (8,11), instead of using the pulse spray technique and t-PA assisted in increasing the surface area of thrombus to enhance the effectiveness of lytic agents, we chose thrombus fragmentation and aspiration techniques with no lytic agents for this patient who had absolute contraindications to thrombolysis.…”

“…For patients with fatal bleeding risks such as recent surgical procedures, intracranial hemorrhage, and other contraindications to thrombolysis, anticoagulation, or surgical thrombectomy; the treatment options are of controversial complexity. The AngioJet rheolytic thrombectomy (ART) system provides pharmacomechanical thrombolysis and has been previously attempted for PE, with promising clinical outcomes despite several adverse events reported (5)(6)(7)(8). Nowadays, transportable extracorporeal membrane oxygenation (ECMO) assistance systems with percutaneous femoral cannulation may become effective in extreme circumstances, maintaining circulation and oxygenation.…”