Chest
Original ResearchPulmonary EmbolismCombined Clot Fragmentation and Aspiration in Patients With Acute Pulmonary Embolism*
Section snippets
Patients
During the period from July 2004 to May 2007, 69 patients were referred to the cardiac catheterization laboratory with a diagnosis of PE, of whom 18 patients met the criteria for massive PE based on the angiographic evidence of a thrombus image in a main pulmonary branch or in two or more lobar branches, and one or more criteria of RVD, the subject of this report. This study was approved by the institutional review board, and informed consent was obtained from all patients.
The criteria applied
Results
Mean age was 51.4 ± 4 years, with male gender predominance (76%). Baseline characteristics of the patients are described in Table 1. The most frequent risk factors were prior deep vein thrombosis and obesity (47.1%); three of our patients were pregnant (23.5%). Among the clinical manifestations, most patients presented dyspnea (94.4%), chest pain (88.9%), and cough (61.1%). sSBP level was 95.3 ± 10.8 mm Hg, with 44.4% of patients having sSBP < 90 mm Hg prior to the procedure; mean heart rate
Discussion
The clinical spectrum of RVD secondary to acute PE is varied. Patients with RVD and sSBP > 90 mm Hg have a high rate of PE recurrence and related death risk. The mortality rate in this group may reach 12.8%, and 10% progress to cardiogenic shock, which is considered secondary to recurrent PE in 50% of the cases.11, 12, 13, 14 Treatment of this group is controversial. The Management Strategy and Prognosis of Pulmonary Embolism Registry reported a 30-day mortality rate of 4.7% with thrombolysis,
Conclusions
The main objective of PMT is to revert RVD or cardiogenic shock secondary to PE. Invasive treatment should be limited to the main or lobar arteries and hemodynamic improvement criteria should be used as guidance to conclude the procedure, regardless of the angiographic result. The device employed in this series (Aspirex) was found to be safe and was not associated with damage to cardiac structures although experience with its use in a larger number of patients is required for a better
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2018, Surgical Clinics of North AmericaCitation Excerpt :It then through its mechanism of action causes fragmentation, maceration, and clearing of the thrombus. Although more widely used in acute deep venous thromboembolism or dialysis access, the Aspirex catheter has some limited evidence to support its use in the treatment of high-risk PE.20,21 The FlowTriever system (Inari Medical, Irvine, CA) uses a wide-bore, hydrophilic 20F aspiration guide catheter that can easily be delivered into the PAs over a standard supportive guidewire.
The authors have no actual or potential conflicts of interest to disclose.
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