Catheter-directed mechanical thrombectomy ‘highly successful’ for PE
MedWire News: Catheter-directed mechanical thrombectomy (CDMT) is highly successful for the treatment of pulmonary embolism (PE) in both normal- and high-risk patients, say US surgeons.
Writing in the Annals of Vascular Surgery, the team advocates wider use of their algorithm to direct the use of CDMT as a primary treatment for either massive or submassive PE.
"Experience and strict patient selection criteria may improve therapeutic outcomes," they add.
Naiem Nassiri (Lennox Hill Hospital, New York) and team reviewed outcomes of 15 consecutive patients managed according to the algorithm at their institution between 2008 and 2010.
All patients had evidence of saddle, main branch, or multilobar PE on computed tomography, in the setting of hypoxia, tachycardia, echocardiographic right heart strain, and/or cardiogenic shock.
All patients were managed with CDMT using an AngioJet (MedRad Inc.) catheter. The 10 patients without bleeding contraindications received adjunctive thrombolysis (recombinant tissue plasminogen activator delivered via power-pulse spray). In addition, 10 patients received an inferior vena cava filter.
Post-procedure angiography revealed significant clot resolution in nine patients, moderate resolution in five, and minimal resolution in one patient. All 10 patients who received thrombolysis had moderate-to-significant clot resolution.
A total of three (20%) patients suffered complications. Two developed acute tubular necrosis and one suffered an intraoperative cardiac arrest, from which she recovered fully. "Of note, she did not receive preprocedural aminophylline infusion," remark Nassiri et al.
Encouragingly, there were no in-hospital recurrences or deaths and all patients were asymptomatic at discharge. All patients were discharged on full oral anticoagulation and none required supplemental oxygen.
Finally, postoperative transthoracic echocardiography revealed improvement or resolution of right heart strain in all patients, as well as normalization of cardiac enzymes in all cases.
The authors conclude: "CDMT as primary treatment of massive and submassive PE is an effective and relatively safe tool, but does have its own unique set of complications. This requires large volume experience and awareness of potential technical pitfalls.
"Dedicated catheter technology and further clinical experience are needed for proper incorporation of protocols into randomized clinical trials for prospective comparison against some of the more established therapeutic options such as systemic thrombolysis and surgical embolectomy."
By Joanna Lyford