Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: Results of quantitative evaluation

19 Jul

Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: Results of quantitative evaluationThe results of quantitative evaluation of the angiograms according to the angiographic severity index are given in Table 3. Its decrease prefragmentation to postfragmentation was highly significant (p < 0.001). According to the definition of fragmentation success, three cases were refractory to this therapy (No. 3,6,10), which is equal to a success rate of 70%. The overall mean percentage of recanalization by fragmentation was 29.2 ± 14.0% (range, 11 to 57%). The mean percentage exclusively of the seven successful cases accounted for 36.0 ± 10.0% (range, 25 to 57%).
In 2 of 10 patients, thrombolytic therapy was absolutely contraindicated (Table 4). read Additional thrombolysis with plasminogen activator (rt-PA, Actilyse; Thomae; Biberach/Riss, Germany) was performed in the remaining eight cases (five relative contraindications, three without contraindications, Table 4). The eight patients received a mean dose of 63 ± 25 mg. Only in two of eight patients was the approved maximum dose (100 mg) administered. Bleeding complications did not occur. In a patient with heparin-induced thrombocytopenia syndrome and a large, consistent central embolus (No. 3), thrombolysis with 60 mg rt-PA failed to achieve any improvement. After subsequent fragmentation, which showed only marginal improvement, thrombolysis was continued with urokinase (Rheotromb; Curasan; Kleinostheim, Germany) for 3 days.
There were no complications related to angiography or to the fragmentation procedure. One patient (No. 9), who underwent repeated cardiopulmonary resuscitation, died from right heart failure 1 h after fragmentation, despite a successful partial recanalization. This was classified as a medical adverse event. In the other nine patients, no adverse events happened within the 48-h follow-up interval (Table 5). Circulatory restitution at 48 h was achieved in five patients, and in a further patient (No. 1), considering that the pulmonary hypertension was chronic (Table 5). This is equal to a 48-h treatment success rate of 60%. The remaining cases did not fulfill the criteria of shock index < 1 (No. 7,9,10), mean pulmonary arterial pressure < 25 mm Hg (No. 3,7,9), and normalized systemic arterial BP (No. 9,10).