Treatment of acute pulmonary embolism using rheolytic thrombectomy

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

“…In comparison to those in untreated segments, ART resulted in a significant intima/ media thinning with a reduction in intact endothelium and an increase in staining for heat shock protein 90 expression with immunohistology staining (26). These results seem to be consistent with a potential risk for local thermal injury with/or without Additional concerns related to hemolysis are the occurrence of severe hyperkalemia and hemoglobinuria (22)(23)(24)(25)28). Hyperkalemia may exacerbate the electrical instability, and hemoglobinuria may cause acute deterioration of kidney function in these patients already at risk because of hemodynamic instability and contrast utilization for diagnostic computed tomography angiographic evaluation and selective pulmonary arterial injections during the ART procedure (22)(23)(24)(25)28).…”

“…A recently published single-center ART study, which included 44 patients with acute PE in total (21 HR and 23 IHR), provided robust data for efficacy and safety concerns of this CDT system (25). The mean duration of overall ART activation runs was 156.6±59.1 seconds (ranging from 78 to 280 seconds), and adjunctive local urokinase was used in 90.9% of them (25).…”

“…The AngioJet rheolytic thrombectomy (ART) (Possis Medical, Minneapolis, Minnesota, USA) system is a widely used CDT device that uses high pressure and circumferential saline jet expulsions at the catheter tip (2,500 psi or 1.7-107 Pa) to create a local low-pressure zone via Bernoulli's principle of fluid dynamics to entrain, fragment, and aspirate thrombi even if the catheter is positioned several millimeters away from the occlusive clot. Moreover, the on-the-wire design of ART permits aspiration thrombectomy procedures along all the subsegmentary pulmonary artery branches selected (18)(19)(20)(21)(22)(23)(24)(25). ART seems to be an efficacious CDT device in terms of thrombus fragmentation/aspiration, as well as improvement of clinical measures in massive and sub-massive PE (18)(19)(20)(21)(22)(23)(24)(25).…”

“…Moreover, the on-the-wire design of ART permits aspiration thrombectomy procedures along all the subsegmentary pulmonary artery branches selected (18)(19)(20)(21)(22)(23)(24)(25). ART seems to be an efficacious CDT device in terms of thrombus fragmentation/aspiration, as well as improvement of clinical measures in massive and sub-massive PE (18)(19)(20)(21)(22)(23)(24)(25). However, the mortality rate in unstable settings remains high, and a controversy exists regarding the safety of ART (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”

“…ART seems to be an efficacious CDT device in terms of thrombus fragmentation/aspiration, as well as improvement of clinical measures in massive and sub-massive PE (18)(19)(20)(21)(22)(23)(24)(25). However, the mortality rate in unstable settings remains high, and a controversy exists regarding the safety of ART (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28).…”