Massive Pulmonary Embolism: Treatment with Thrombus Fragmentation and Local Fibrinolysis with Recombinant Human-Tissue Plasminogen Activator

Stock, K.; Jacob, Augustinus Ludwig; Schnabel, Karl Jakob; Bongartz, Georg; Steinbrich, W.

doi:10.1007/s002709900169

Cited by 44 publications

(17 citation statements)

References 16 publications

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“…Further studies are indicated to determine the most effective bolus dose, infusion rate and total dose of r-TPA that should be administered. Although higher doses of r-TPA were used in this study than in standard peripheral intravenous thrombolysis, and higher doses were used than in the study by Stock et al [30], no patient suffered haemorrhagic complications [7,12]. No patient had a contraindication to thrombolysis, but patient 4 had had a coronary artery bypass graft 17 days prior to thrombolytic therapy.…”

Section: Discussionmentioning

confidence: 91%

“…Angiographic appearances improved, systemic blood pressure increased and right ventricular end diastolic and pulmonary artery pressures fell following mechanical clot fragmentation and administration of the bolus dose of streptokinase. Stock et al have recently reported five patients with massive PE in whom clot fragmentation was performed using a balloon catheter in addition to standard guidewires and angiographic catheters and in whom r-TPA was used as the local thrombolytic agent [30]. All patients were successfully treated with a significant decrease in pulmonary arterial pressure being recorded after treatment.…”

Section: Discussionmentioning

confidence: 94%

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Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

et al. 1999

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The purpose of this article is to report four patients with massive pulmonary embolism treated with percutaneous catheter and guidewire fragmentation and local administration of recombinant tissue plasminogen activator (r-TPA). Four patients with massive pulmonary embolism initially underwent pulmonary angiography. Thrombus fragmentation was performed with both standard angiographic guidewires and catheters followed by local infusion of 41-200 mg of r-TPA. Pulmonary angiography was repeated after treatment. All patients survived with improvement in their clinical status and eventual discharge from hospital. Angiography in all patients post treatment demonstrated improvement in pulmonary perfusion (mean Miller score before treatment 22.5; mean Miller score after treatment 5.75). No patient had a significant complication. Mechanical fragmentation of the thrombus followed by local infusion of r-TPA was an effective treatment for massive pulmonary embolism in these four patients with no significant complications.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 94%

Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

et al. 1999

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“…Über den Einsatz einer Kombination von lokaler Katheterfragmentation in der frühen postoperativen Phase mit lokaler Lyse liegen nur anekdotische Berichte vor [1,10,25,26,35], ein Fall nach einem vergleichbar großen viszeralchirurgischen Oberbaucheingriff wird in der Literatur nicht beschrieben.…”

Section: Diskussionunclassified

“…Es stehen verschiedene Systeme zur perkutanen Embolektomie sowie zur Katheterfragmentation und -thrombektomie zur Verfügung [3,8,13,19,21,23,26,30,31,32,33,34,35].…”

Section: Diskussionunclassified

Erfolgreiche lokale Katheterfragmentation und Thrombolyse bei akuter Lungenembolie in der frühen postoperativen Phase nach Pankreaskopfresektion

Obermaier

Kröger

Benz

et al. 2002

Chirurg

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Pulmonary embolism in the early postoperative period is characterized by high morbidity and mortality. Systemic application of thrombolytic agents during this time is contraindicated; operative thrombectomy also has a high mortality rate. We report a case of successful local lysis in combination with catheter fragmentation of a massive two-sided pulmonary embolism diagnosed on the 4th postoperative day after pylorus-preserving duodenopancreatectomy for distal carcinoma of the common bile duct. Thrombolysis was performed in three sessions by a combination of catheter-supported interventional fragmentation of the thrombus with local rt-PA lysis. There were no bleeding complications or disturbances of anastomotic healing. The patient was discharged from the hospital on the 23rd postoperative day after changing anticoagulation to a vitamin K antagonist. The case presented demonstrates the possibility of local lysis in combination with interventional methods as a therapeutic option for pulmonary embolism in the early postoperative period as an alternative to surgical strategies.

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“…in Kombination mit einer kathetergestützten Thrombusfragmentation, eine sinnvolle und effektive Therapieoption darstellen kann[2,8,22,23,25,27]. Des Weiteren bleibt dem Patienten durch das interventionelle Verfahren ein operatives Vorgehen mit seiner eigenen postoperativen Morbidität und Letalität erspart[21].…”

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49-jährige Patientin mit tiefer Beinvenenthrombose, Lungenembolie und linksseitiger Hemiparese

et al. 2008

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We report the case of a 49-year-old female patient who was admitted stationary because of a left-sided paralysis which had appeared some hours before. An embolic occlusion of the right A. cerebri media turned out to be the cause. A paradoxical embolism could be assumed because of an existing deep vein thrombosis and an increased right-ventricular pressure within a hemodynamically relevant fulminant pulmonary embolism as well as the additional existence of a patent foramen ovale (PFO). Systemic lysis as treatment of the pulmonary embolism was contraindicated because slight bleeding had occurred in the area of the right basal ganglia after treatment of the embolic occlusion of the right A. cerebri media by a local lysis. Subsequently and in the acuteness, a catheter interventional PFO-closure via a double-umbrella device was placed and the pulmonary embolism was effectively treated by a local lysis through the insertion of a pigtail-catheter into the right pulmonary artery.

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Massive Pulmonary Embolism: Treatment with Thrombus Fragmentation and Local Fibrinolysis with Recombinant Human-Tissue Plasminogen Activator

Abstract: Clot fragmentation and local fibrinolysis with rtPA was an effective therapy for massive pulmonary embolism. Bleeding at the puncture site was a frequent complication.

Cited by 44 publications

References 16 publications

Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

Erfolgreiche lokale Katheterfragmentation und Thrombolyse bei akuter Lungenembolie in der frühen postoperativen Phase nach Pankreaskopfresektion

49-jährige Patientin mit tiefer Beinvenenthrombose, Lungenembolie und linksseitiger Hemiparese

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