Catheter-Directed Embolectomy Life-Saving in Massive Pulmonary Embolism

Catheter-directed intervention can be life-saving for patients with massive pulmonary embolism (PE) who fail to respond to or cannot receive systemic thrombolysis, according to a report in the August issue of Chest. "Catheter-directed intervention is now a viable treatment option for massive PE at centers with the appropriate expertise," Dr. William T. Kuo from Stanford University Medical Center in California told Reuters Health. "This treatment is likely to be much safer and more effective than standard treatment with intravenous tPA."

Dr. Kuo and colleagues evaluated the effectiveness of catheter-directed intervention, including embolectomy, fragmentation, with or without local thrombolysis, as part of a treatment algorithm for the management of life-threatening PE.

Among 12 patients referred for catheter-directed intervention, 7 had no response to intravenous tPA, and 5 had contraindications to thrombolytic therapy.

Catheter-directed intervention was technically successful in all 12 patients, the authors report, with no major procedural complications.

There were minor complications in two patients, the report indicates, including groin hematoma in one patient and transient bradycardia during activation of the rheolytic catheter in one patient.

Ten of the 12 patients also received an inferior vena cava filter for PE prophylaxis after the procedure. All 12 patients experienced an increase in pulmonary perfusion after catheter-directed intervention, the researchers note, and 10 of 12 patients had significant hemodynamic improvement.

The two patients who failed to show significant hemodynamic improvement died secondary to cardiac arrest within 24 hours of treatment.

"In the setting of hemodynamic shock from massive PE, catheter-directed intervention may be performed with or without local thrombolysis and may be useful in patients who have not responded to or cannot tolerate thrombolysis," the authors conclude.

"This treatment may be effective for some patients with sub-massive PE, but further research is needed," Dr. Kuo said. "We need to figure out exactly which patients with sub-massive PE (i.e., those with right heart strain, troponin abnormality) are appropriate candidates for intervention."

His group, the Stanford Division of Vascular and Interventional Radiology, is working with Dr. Sam Goldhaber and the North American Thrombosis Forum to create an International Registry to investigate the safety and efficacy of Catheter-Directed Therapy for the Treatment of Acute PE, Dr. Kuo added.

Chest 2008;134:250-254.

Reviewed by Ramaz Mitaishvili, MD

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