<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2020-0006_s_005_w2aab3b8c82b1b7b1aab1c16b1Aa"><h3>Background</h3><p>High-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.</p></sec><sec id="j_raon-2020-0006_s_006_w2aab3b8c82b1b7b1aab1c16b2Aa"><h3>Patients and methods</h3><p>This 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.</p></sec><sec id="j_raon-2020-0006_s_007_w2aab3b8c82b1b7b1aab1c16b3Aa"><h3>Results</h3><p>From 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 <italic>vs</italic> 119 ± 34; p = 0.100) and heart frequency (99 ± 35 min<sup>-1</sup><italic>vs</italic> 87 ± 31 min<sup>-1</sup>; p = 0.326) before and after treatment, respectively. Peak systolic tricuspid pressure gradient was significantly lower after treatment (57 ± 14 mm Hg <italic>vs</italic> 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.</p></sec><sec id="j_raon-2020-0006_s_008_w2aab3b8c82b1b7b1aab1c16b4Aa"><h3>Conclusions</h3><p>In patients with high-risk pulmonary embolism who cannot receive thrombolytic therapy, percutaneous mechanical thrombectomy is a promising alternative to reduce pulmonary artery pressure.</p></sec></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.

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

Radiology and Oncology

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BackgroundHigh-risk pulmonary embolism is associated with a high early mortality rate. We report our experience with percutaneous mechanical thrombectomy in...

Clinical characteristic (n=25)	Before PMT	After PMT	P value
Heart rate, min^-1	100.2 ± 34.5	86.6 ± 31.3	0.326
Arterial systolic pressure, mm Hg	91.6 ± 40.0	121.9 ± 34.3	0.100
Peak systolic tricuspid pressure gradient, mm Hg	55.4 ± 13.3	29.8 ± 5.2	0.018

Clinical characteristic	All patients (n =25)	PMT without lysis (n = 17)	Systemic or local lysis + PMT (n = 8)	p-value
Age, years	62.6 ± 12.7	66.1 ± 11.2	55.4 ± 13.5	0.05
Breathing frequency before, min^-1	21.6 ± 10.1	24.4 ± 8.6	16.8 ± 12.0	0.25
sPESI score	2.9 ± 0.7	3.1 ± 0.7	2.6 ± 0.5	0.11
Max. lactate, mmol/L	7.8 ± 6.6	5.5 ± 7.1	10.7 ± 4.6	0.10
Max troponin I, μg/L	5.6 ± 10.8	2.4 ± 3.4	10.6 ± 16.3	0.09
Technical success, %	80	82	75	0.67
Survival to hospital discharge, %	68	76	50	0.19
Cardiogenic schock, %	67	54	88	0.11
Mechanical ventilation, %	61	47	88	0.06
Vasopressors or inotropes, %	77	71	88	0.18
Bleeding, %	16	12	25	0.40
Transfusion, %	24	12	50	0.04
Aspirex, %	44	53	25	0.19

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

Article Category: Research Article

Pubblicato online: 14 feb 2020

Pagine: 62 - 67

Ricevuto: 24 nov 2019

Accettato: 23 gen 2020

DOI: https://doi.org/10.2478/raon-2020-0006

© 2020 Matjaz Bunc, Klemen Steblovnik, Simona Zorman, Peter Popovic, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Effects of mechanical percutaneous mechanical thrombectomy (PMT)

Characteristics of the study group