[Percutaneous rheolytic thrombectomy with AngioJet for pulmonary embolism: methods and results in the experience of a high-volume center].

Abstract

BACKGROUND:

Pulmonary embolism is a common disease with significant mortality. Anticoagulant and thrombolytic therapies are a mainstay in the management of acute pulmonary embolism, especially with hemodynamic compromise. However, systemic drugs cannot achieve timely and effective treatment of acute pulmonary embolism in all patients. Recently, rheolytic thrombectomy has been proven to be effective in the treatment of massive thrombosis in vein grafts. The purpose of this study was to describe the rheolytic thrombectomy procedure and to evaluate the efficacy of thrombus removal using the AngioJet catheter in patients with acute massive and submassive pulmonary embolism.

METHODS:

Thirty consecutive patients (16 men, 14 women, mean age 67.9 +/- 13.5 years) with massive or submassive pulmonary embolism were treated with rheolytic thrombectomy. The Miller index and the systolic pulmonary pressure were evaluated pre- and post-rheolytic thrombectomy. In-hospital results were analyzed according to the learning curve of operators.

RESULTS:

Technical success was achieved in 93.3% of patients. Eleven patients received adjunctive loco-regional thrombolytic agent (alteplase) or abciximab. A significant improvement in the obstruction, perfusion and Miller indexes and in the systolic pulmonary pressure was observed after rheolytic thrombectomy (p <0.0001) in all patients. The achievement of a larger experience by the operators was associated with a less procedural complication rate (i.e. post-procedural increase in creatinine, cardiac arrest during the procedure, post-procedural hemoptysis, and in-hospital mortality). Total in-hospital mortality occurred in 5 patients (16.7%), 60% of them presented with cardiogenic shock. All patients were alive at the 12-month follow-up, except one who died after 3 months for myocardial infarction.

CONCLUSIONS:

Percutaneous rheolytic thrombectomy using the AngioJet catheter may be a valid treatment option for patients with massive or submassive pulmonary embolism with rapid and significant hemodynamic improvement and encouraging results at early and long-term follow-up. Greater laboratory and operator experience yield better clinical results.

• Authors: Sabine Vecchio, Guido Vittori, Tania Chechi, Gaia Spaziani, Alessio Lilli, Gabriele Giuliani, Lorenzo Consoli, Giuseppe Ambrosio, Massimo Margheri
• Journal: Giornale italiano di cardiologia (2006) (G Ital Cardiol (Rome)) Vol. 9 Issue 5 Pg. 355-63 (May 2008) ISSN: 1827-6806 [Print] Italy
• Vernacular Title: Trombectomia reolitica percutanea con AngioJet nell'embolia polmonare: metodologia e risultati nell'esperienza di un centro ad alto volume.
• PMID: 18678226 (Publication Type: English Abstract, Journal Article)

Topics

• Aged
• Catheterization
• Female
• Humans
• Male
• Pulmonary Embolism (surgery)
• Retrospective Studies
• Thrombectomy (methods)