Pulmonary angiography was accomplished at a cardiologic angiography unit (Siemens Coroskop HIP; Siemens Medical Systems; Erlangen, Germany) using cine mode with a frame rate of 25/s. Initial angiography was done either with the fragmentation catheter at a flow rate of 15 mL/s or with a 7F standard pigtail catheter at a flow rate of 14 to 18 mL/s and an injected volume of 30 to 40 mL. Additional intrapulmonary checks during and after fragmentation were performed with the fragmentation catheter.
After initial bilateral angiography and confirmation of the diagnosis, the fragmentation catheter was positioned with the wire exiting the side hole. The side of predominant occlusion was treated, in one case both sides Link buy dexone online. The central part of the embolus was fragmented first, and subsequently the more peripherally located portions. After the fragmentation procedure, a Swan-Ganz-catheter (Baxter Healthcare; Irvine, CA) was exchanged allowing subsequent hemodynamic monitoring. Clinical folknv-up at an ICU lasted for at least 48 h.
The application of thrombolytic therapy as the gold standard in acute massive pulmonary embolism was not restricted in any way by the study protocol. Total dose, dose distribution, starting point, and mode of delivery was left to the operator’s decision according to the particular circumstances (cardiopulmonary status, consideration of possible contraindications) of each individual case.
Quantitative angiographic assessment of prefragmentation and postfragmentation angiograms was performed by three examiners independently using the “angiographic severity index for pulmonary embolism” defined by Walsh et al.* The occluded area (expressed as a percentage) was calculated before and after treatment by the individual occlusion score for each lung related to the maximum score of 9.
Recanalization of occluded area (expressed as a percentage) was calculated as the difference between pretreatment and posttreatment occlusion, related to the pretreatment occlusion.