Percutaneous mechanical thrombectomy for the treatment of acute massive pulmonary embolism: case report

Abstract

Background: To our knowledge we report the first case of percutaneous mechanical thrombectomy used for the treatment of massive pulmonary embolism in the United Kingdom. Pulmonary embolism is a common disease process but can be difficult to diagnose. Massive pulmonary embolism presenting with profound hypotension, however, is rare. Both phenomena carry with them significant mortality. Traditionally those patients suffering haemodynamic compromise from pulmonary embolism are treated with intravenous or catheter-directed thrombolysis. When this is contraindicated surgical embolectomy or mechanical techniques via a right heart catheter are alternative options. The former is well established but the latter is less commonly utilised in clinical practice. Our aim is to highlight the effectiveness and relative safety of percutaneous mechanical thrombectomy as a therapeutic tool in massive pulmonary embolism.

Concomitant percutaneous embolectomy and thrombolysis in the treatment of early massive pulmonary embolism secondary to abdominal trauma – A case report and a review

“…5,18 In this case, given the high percentage of poor outcomes for mechanical thrombectomy due to peripheral embolisms and the severity of our patient, it was decided to add thrombolysis with intermediate doses of urokinase for mechanical thrombectomy. 4,8,13,15,16 Our patient's outcome was good and she had no hemorrhagic complications. To our knowledge, this is the first reported case with concomitant mechanical thrombectomy, arterial thrombolysis and inferior vena cava filter placement.…”

Percutaneous Thrombectomy for the Treatment of Acute Massive Pulmonary Embolism: Two Case Reports

“…However, the major complications of PT include renal failure, bradycardia, stroke, and death; they constitute less than 5.0% of overall cases. 10,11 There are two types of mechanism of thrombus removal, which can be broadly divided into mechanical thrombectomy and suction thrombectomy. 5 Mechanical thrombectomy involves breaking the clot before removing it, which can be done via a simple procedure such as rotating the catheter within the thrombus, using an angioplasty balloon, or using more sophisticated devices as is the case in rheolytic thrombectomy.…”

Percutaneous Mechanical Thrombectomy for Massive Pulmonary Embolism Using a Conservative Treatment Strategy

“…Comparison of Morbidity with Other Case Series of PMT Morbidity in the present study is lower than what has been reported in prior case series. A review of the literature published to date using the Angiojet system for PMT of massive PE reveals 83 patients 11–15,17–30 . In 22% of those patients (18 of 83) some form of bleeding complication was reported such as bleeding–not further specified, hemoptysis, or the need for transfusion (Table 3).…”

“…A review of the literature published to date using the Angiojet system for PMT of massive PE reveals 83 patients. [11][12][13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30] In 22% of those patients (18 of 83) some form of bleeding complication was reported such as bleeding-not further specified, hemoptysis, or the need for transfusion ( Table 3). Several of those reported bleeding episodes may be due to vascular access and not necessarily related to the PMT procedure.…”