Mechanical and Enzymatic Thrombolysis for Massive Pulmonary Embolism
Section snippets
Patient Population
From January 1994 until June 2000, 59 patients with diagnosed massive PTE with severe (life-threatening) hemodynamic instability were treated, 25 of them men (42.7%) and 34 women (57.6%), with a mean age of 54.5 y ± 2.08 (range, 22–85 y).
Patients were included who had acute PTE with a Miller index >0.5 (29) and a mean pressure in the main pulmonary artery greater than 30 mm Hg. None of them showed contraindications for fibrinolytic treatment. The Miller index is a quantitative parameter for
Early Results
Technical success (to achieve catheterization, fragmentation, and thrombolysis) was achieved in all cases. (Figure 1, Figure 2). The range of urokinase infusion time was 24 –72 hours and 20 minutes to 2 hours for rt-PA infusion.
After fragmentation and administration of the thrombolytic bolus, clinical improvement was seen in 56 patients (94.9%). This improvement was assessed by the decrease or disappearance of clinical symptoms and by the stabilization of the hemodynamic parameters of heart
DISCUSSION
Hemodynamically unstable massive thromboembolism is a clinical emergency requiring immediate and effective life-supporting therapeutic measures. Anticoagulation with heparin is the basic treatment of venous thromboembolic disease. Various studies have shown the efficacy of fractionated heparin and even lowmolecular-weight heparin for treating hemodynamically stable pulmonary embolism (31, 32).
Different authors have shown that the use of thrombolytic drugs for treatment of pulmonary embolism can
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Percutaneous Interventions for Acute Pulmonary Embolism
2020, Image-Guided Interventions: Expert Radiology Series, Third EditionSurgical pulmonary embolectomy and catheter-based therapies for acute pulmonary embolism: A contemporary systematic review
2018, Journal of Thoracic and Cardiovascular SurgeryCatheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses
2016, International Journal of CardiologyCitation Excerpt :The analysis has been reported in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines [16]. We found 62 studies across all specified categories with 1848 patients and 1872 CDTs [17–78]. We could ascertain the haemodynamic significance of PE in 35 studies.
Impact of catheter fragmentation followed by local intrapulmonary thrombolysis in acute high risk pulmonary embolism as primary therapy
2014, Indian Heart JournalCitation Excerpt :In literature, there is no prior well designed study of catheter based therapy on its effect on right ventricular systolic pressure (RSVP) or estimated pulmonary artery pressure and the development of chronic thromboembolic pulmonary hypertension (CTEPH) at 1 year follow up. Some studies have shown significant 46% reduction in pulmonary artery pressures with no incidence of CTEPH at 3–6 months follow up.32 Similarly pooled analysis of the 4 reported studies showed a significantly greater reduction in estimated pulmonary arterial pressures with fibrinolysis plus heparin compared to heparin alone (mean of 50% vs. 25% respectively) at 6 months follow up.33–36
Endovascular therapy for acute pulmonary embolism
2012, Journal of Vascular and Interventional Radiology
From the SCVIR 2001 Annual Meeting.