Catheter-Directed Embolectomy Could Be a Life-Saver

Patients suffering a massive pulmonary embolism (PE) who fail to respond to or cannot receive systemic thrombolysis could be saved by a catheter-directed intervention (CDI), claims a new study.

Researchers from Stanford University Medical Center (Stanford, CA, USA) conducted a retrospective review of 70 consecutive patients with suspected acute PE over a 10-year period (1997-2006) who had been referred for pulmonary angiography or intervention. The criteria for study inclusion were patients who received CDI due to angiographically confirmed massive PE and hemodynamic shock. The CDI involved suction embolectomy and fragmentation, with or without catheter thrombolysis. In all, 12 patients (7 men and 5 women; mean age 56 years) were treated with CDI. Seven patients (58%) were referred for CDI after failing systemic infusion with 100 mg of tissue plasminogen activator (tPA), and five patients (42%) had contraindications to systemic thrombolysis.

The study found that CDI fragmentation and embolectomy were performed in all 12 patients, and catheter-guided thrombolysis was performed in eight patients (67%). Technical success was achieved in all cases, and there were no major procedural complications. Two patients (17%) died secondary to cardiac arrest within 24 hours. The other patients showed significant hemodynamic improvement, survived the procedure, and remained stable until hospital discharge. There were minor complications in two patients, a groin hematoma in one and transient bradycardia during activation of the rheolytic catheter in the other patient. The study was published in the August 2008, issue of the journal Chest.

"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,” concluded lead author William Kuo, M.D., and colleagues of the division of vascular and interventional radiology. "We need to figure out exactly which patients with sub-massive PE are appropriate candidates for intervention. This treatment is likely to be much safer and more effective than standard treatment with intravenous tPA.”

Related Links:
Stanford University Medical Center