Intervention in Massive Pulmonary Embolus: Catheter Thrombectomy/Thromboaspiration versus Systemic Lysis versus Surgical Thrombectomy

Abstract

Massive pulmonary embolus (PE), defined as hemodynamic shock from acute PE, is a life-threatening condition. Deaths from massive PE, especially when unsuspected, occur within minutes to hours of onset and as such prompt intervention can be lifesaving. Acute massive PE patients have traditionally been candidates for treatment with intravenous systemic thrombolysis to improve pulmonary artery pressure, arteriovenous oxygenation, and pulmonary perfusion in an effort to reduce mortality. However, patients with contraindications to systemic thrombolysis or those who have failed thrombolysis may benefit from other techniques including endovascular and surgical embolectomy. This article will review the current medical management as well as catheter-directed therapies and surgical embolectomy in the treatment of patients with massive PE.

Catheter-directed therapy to treat intermediateand high-risk pulmonary embolism: Personal experience and review of the literature

“…The procedure is deemed a clinical success if the pressure in the PA drops and signs of RV strain decrease. The catheter may then be removed at bedside [ 19 ].…”

“…In addition, the rate of major bleeding complications might be reduced in CDTh, compared with ST. However, a clear mortality benefit of CDTh remains to be demonstrated [ 16 – 19 ]. In this review article, we have summarized devices and technical details for CDTh, discussed the efficacy and safety of CDTh in comparison to ST in the main clinical trials, and outlined future research directions to investigate whether CDTh is a viable alternative to ST in intermediate- and high-risk PE patients, or in those with contraindications to ST.…”

Emergent mechanical thrombectomy for right atrial clot and massive pulmonary embolism using FlowTriever.

“…The 2011 American Heart Association guidelines for surgical embolectomy included patients with massive PE who exhibited contraindications to receive fibrinolysis, or patients who remain unstable after thrombolysis (2). Reported complications of the surgical approach included rethrombosis risk, postoperative bleeding, cardiac tamponade, and sternal wound infection (3).…”