Combined clot fragmentation and thrombus aspiration appears to be beneficial in certain patients with massive angiographic pulmonary embolism (PE), according to Mexican researchers.
Percutaneous mechanical thrombectomy (PMT), lead investigator Dr. Guering Eid-Lidt told Reuters Health, “is an alternative therapy for patients with massive PE or acute PE associated with right ventricular dysfunction unresponsive to the optimal treatment with IV heparin, saline solution, vasoactive catecholamines, and systemic thrombolysis, and in patients with contraindications to systemic thrombolysis, increased bleeding risk or unavailable surgical thrombectomy.”
In the July issue of Chest, Dr. Eid-Lidt and colleagues at Instituto Nacional de Cardiologia “Ignacio Chavez,” Mexico City, report on their study involving 18 patients with massive PE.
All underwent thrombus fragmentation using a pigtail catheter and 13 also had thrombus aspiration. A percutaneous thrombectomy device (Aspirex, Straub Medical) was employed in 11 patients.
Following the procedure, there was a significant increase in systolic systemic BP and a significant decrease in mean pulmonary artery pressure.
One in-hospital death occurred, attributed to PE, and another patient had intracerebral hemorrhage with minor neurological sequelae. However, during more than a year of follow-up, there were no cardiovascular deaths or recurrent pulmonary thromboembolism.
“The main objective of the treatment in patients with massive PE is to reduce right ventricular afterload and increase the systemic blood pressure,” added Dr. Eid-Lidt. “PMT performed in highly qualified centers can improve the hemodynamic instability, because it has the potential benefit of quickly reversing the right ventricular dysfunction.”
In an accompanying editorial, Dr. Samuel Z. Goldhaber of Brigham and Women’s Hospital, Boston and Dr. Nils Kucher of University Hospital Zurich, call the results “convincing” but they also point out that the study was small and that pulmonary artery interventions have the potential for fatal complications.
They therefore recommend that the procedure “should be reserved for PE patients at high risk of death from right ventricular failure.”
Chest 2008;134:54-60.
Reviewed by Ramaz Mitaishvili, MD
