Massive Pulmonary Embolism: Treatment with the Hydrolyser Thrombectomy Catheter

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PURPOSE

To assess the efficacy of clot removal with use of the Hydrolyser thrombectomy catheter in acute massive pulmonary embolism (PE).

MATERIALS AND METHODS

Eleven patients (eight women, three men) with a mean age of 61 (range, 37–79) years with acute massive PE underwent percutaneous mechanical thrombectomy (PMT) with use of the Hydrolyser. In four patients with no contraindication, fibrinolysis was performed with use of urokinase at low doses after thrombectomy.

RESULTS

Ten patients (90.9%) recovered from massive PE and were discharged within 11 days. The Urokinase Pulmonary Embolism Trial angiographic severity indexes (mean ± SD) were 14.7 ± 2.6 and 7.5 ± 2.7, respectively, before and after thrombectomy (P < .001). Partial arterial pressures of O2 increased from 72.8 mm Hg ± 16.4 to 93.5 mm Hg ± 5.6 (P < .005). Pulmonary artery pressure decreased from 45.5 mm Hg ± 14.2 to 29.5 mm Hg ± 13.6 after thrombectomy (P < .0001). Calculated by semiquantitative computed analysis, PMT with use of the Hydrolyser removed 74.06% of thrombus ± 13.46%. One patient developed self-limited hemoptysis immediately after thrombectomy. One patient died during the procedure secondary to PE.

CONCLUSION

PMT with use of the Hydrolyser is effective and safe in massive PE, resulting in improved hemodynamics and blood oxygenation and decreased pulmonary artery pressure. It offers an alternative to fibrinolysis and surgical thrombectomy.

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PATIENTS AND METHODS

We treated 11 patients (eight women, three men) with mean age of 61 years (range, 37–79 y) in a prospective protocol. All were inpatients who entered the hospital for surgery, trauma, or other causes without symptoms of PE or DVT and developed thromboembolic disease during their hospital stay. These patients had acute onset (<5 days) of symptoms of PE with hemodynamic compromise, pulmonary hypertension, and right ventricle overload. Five patients had contraindications to thrombolytic drugs

RESULTS

Ten patients (90.9%) recovered from massive PE and were discharged within 11 days. A representative case is shown in Figure 2.

With this technique, we removed a mean of 74.06% of thrombus (± 13.46%), calculated by semiquantitative computed analysis (Fig 3 shows analysis of the case in Fig 2). The angiographic severity indexes before and after thrombectomy were 14.7 ± 2.6 and 7.5 ± 2.7, respectively (P < .001) (Fig 4).

Pulmonary artery pressure decreased from a mean of 45.5 mm Hg ± 14.2 to 29.5 mm

DISCUSSION

The present study evaluated the therapeutic results of PMT in acute massive PE with use of a hydrodynamic thrombectomy catheter in a small number of selected patients. We included only patients with thromboembolic disease that had developed during their hospital stay to assure a short evolution time, because the Hydrolyser works better on fresh, nonorganized thrombus (5). Approximately 74% of thrombus was removed with use of the Hydrolyser. Ninety-one percent of patients (10 of 11) recovered

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From the 1999 SCVIR Annual Meeting.

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