Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy

Abstract

BackgroundHigh-risk pulmonary embolism is associated with a high early mortality rate. We report our experience with percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy.Patients and methodsThis was a retrospective analysis of consecutive patients with high-risk pulmonary embolism and contraindications to thrombolytic therapy. They were treated with percutaneous mechanical thrombectomy which included thrombectomy and additional thrombus aspiration when needed. Clinical parameters and survival to discharge were measured.ResultsFrom November 2005 to September 2015 we treated 25 patients with a mean age of 62.6 ± 12.7 years, 64% were men. Mean simplified Pulmonary Embolism Severity Index was 2.9. Mean maximum lactate levels were 7.8 ± 6.6 mmol/L, vasopressors were used in 77%, and 59% needed mechanical ventilation. Mechanical treatment included thrombus fragmentation complemented with aspiration (56%) and aspiration using Aspirex®S catheter (44%). Local (5 patients; 20%) and systemic (3 patients; 12%) thrombolytics were used as a salvage therapy. We observed nonsignificant improvements in systemic blood pressure (100 ± 41 mm Hg vs 119 ± 34; p = 0.100) and heart frequency (99 ± 35 min-1vs 87 ± 31 min-1; p = 0.326) before and after treatment, respectively. Peak systolic tricuspid pressure gradient was significantly lower after treatment (57 ± 14 mm Hg vs 31 ± 3 mm Hg; p = 0.018). Overall the procedure was technically successful in 20 patients (80%) and 17 patients (68%) survived to hospital discharge.ConclusionsIn patients with high-risk pulmonary embolism who cannot receive thrombolytic therapy, percutaneous mechanical thrombectomy is a promising alternative to reduce pulmonary artery pressure.

Sex Differences in Outcomes of Percutaneous Pulmonary Artery Thrombectomy in Patients With Pulmonary Embolism

“…19 Although studies with smaller sample sizes have described overall outcomes of percutaneous pulmonary artery thrombectomy, data focusing on sex disparities do not exist. 6,[20][21][22][23][24][25][26][27][28] In a singlecenter study of 14 patients, in-hospital mortality of 14% was reported, similar to that seen in our study. 27 A multicenter analysis of the Pulmonary Embolism…”

“…In another review of patients undergoing thrombectomy, a clinical success rate of 81% to 95% was reported. 22 Bunc et al 28 approximately 32% among a small sample of 25 patients who were treated at a single center with percutaneous pulmonary artery thrombectomy. In a more contemporary retrospective analysis of 34 patients undergoing aspiration thrombectomy, in-hospital mortality of 3% was reported, with even lower complication rates reported in clinical trials.…”

Percutaneous stent implantation for occluded central shunts in adults: A case report and review of current evidence

“…Catheter-based mechanical clot disruption may be an excellent alternative therapeutic method to pharmacologic thrombolysis in cases where thrombolytic therapy is contraindicated, such as patients with recent surgery or such potentially bleeding conditions, or ineffective (60)(61)(62). The pharmacologic dissolution of thrombus to fragments using low dose r-tPA and dislodging the occlusive clot with catheter manipulation and/or balloon angioplasty could be applied in situ for declotting the life-threatening thrombotic shunt.…”

Percutaneous mechanical thrombectomy and extracorporeal membranous oxygenation: A case series

“…Individual case reports have described the utility of VA‐ECMO and LBT in high‐risk PE patients 8,9 . To our knowledge, this is the first case series describing the use of VA‐ECMO and LBT in the intermediate‐high‐ and high‐risk PE patients 10 . In this report, we describe the presentation, management, and outcomes of a consecutive series of PE patients with hemodynamic compromise requiring VA‐ECMO and LBT.…”

“…8,9 To our knowledge, this is the first case series describing the use of VA-ECMO and LBT in the intermediate-high-and high-risk PE patients. 10 In this report, we describe the presentation, management, and outcomes of a consecutive series of PE patients with hemodynamic compromise requiring VA-ECMO and LBT. We selected all patients with PERT activation who required VA-ECMO and LBT within 24 hours of PERT activation.…”