Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: Experimental recanalization of the pulmonary arteries

25 Jul
2014

Average degree of experimental recanalization of the pulmonary arteries was 53 ± 21%. In comparison, quantitative evaluation of the angiograms of the present clinical study showed an overall average percentage of recanalization prefragmentation to postfragmentation of 29.2 ± 14.0%, with exclusion of the three “unsuccessful” cases 36.0 ± 10.0%, respectively. While experimental results were obtained by fragmentation of nonorganized “fresh” thrombus, clinical procedures had to deal with partly or completely organized emboli, less prone to fragmentation. This explains the lower recanalization rate observed.
In comparison, Timsit et al reported a recanalization rate of 15.4% (decrease in Miller index from 26/34 to 22/34) for the catheter embolectomy procedure in 11 of 18 patients (“success group,” excluding the unsuccessful cases).
With an average total procedure time of 41 min and an average real fragmentation time of 17 min, the recanalization rate achieved by pigtail fragmentation was rapidly accomplished and compares well with the results given in the literature for thrombolysis as the medical standard therapy. Canadian neighborhood pharmacy other Multicenter studies with actual dosing regimens report a reduction of the angiographic score after 2 h by 17.8% (urokinase) and 22.4% (rt-PA), after 12 to 18 h by 30 ± 25% (urokinase) and 24 ± 18% (rt-PA), and after 24 to 48 h by 33 ± 15% (rt-PA) and 43 ± 13% (streptokinase).
Hemodynamic response of partial recanalization is expressed by the significant decrease in average shock index prefragmentation to postfragmentation. A further decrease within the 48-h interval has to be attributed to the synergy of fragmentation and thrombolytic therapy in 8 of the 10 cases. The average dose administered was below the approved maximum dose and bleeding complications did not occur. Although this should not be overinterpreted with regard to the small number of cases, it might indicate the possibility of dose reduction and reduction of complications in a combined synergistic therapy scheme of fragmentation and thrombolysis.

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