Our success and mortality rates compare favorably with those of surgical pulmonary embolectomy, indicating that fragmentation therapy may serve as an alternative to surgery, if thrombolysis threatens to fail. They are also comparable with similar percutaneous procedures reported in the literature. For the catheter embolectomy procedure, Greenfield et al reported a 30-day survival rate of 70% and Timsit et al” reported an overall long-term survival rate of 72%.
This preliminary clinical study suggests that percutaneous treatment of acute massive pulmonary embolism with the pigtail rotation catheter may represent a new option, especially in emergency patients threatened by right ventricular failure, as an adjunct to thrombolysis and as an alternative to surgical embolectomy. Allergy treatment so The procedure may be also useful outside the ICU. The concept is simple, does not require special skills, can be rapidly accomplished, joins closely with diagnostic angiography, without the need for a catheter exchange, and did not show any device- or procedure-related complications. Central pluglike occlusions seem to be most suitable for fragmentation. However, our results clearly demonstrate that fragmentation recanalizes only parts of the occlusion.
Possible drawbacks of the fragmentation concept include cases with complete embolic “cast,” including the periphery of the pulmonary arteries, emboli in dilated central arteries with a relative small periphery in chronic pulmonary arterial hypertension, consistent organized emboli, not prone to fragmentation, and pulmonary vasoconstriction, probably due to mechanically induced neurohumoral mediator release, which is still subject of investigation.
A phase II study including additional centers and with an improved catheter design (increased shaft diameter, different pigtail sizes for main and lobar pulmonary arteries, and an improved rotation technique) is underway.