Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: Outcome

27 Jul
2014

Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter: OutcomeSystolic and diastolic pulmonary artery pressure decreased slightly but significantly prefragmentation to postfragmentation. However, in average, there was no significant decrease of the mean arterial pulmonary pressure. This was mainly due to a case with only marginal angiographic improvement after fragmentation and two other cases with angio-graphically proven recanalization and decrease of shock index, but unchanged or slightly increased pulmonary arterial pressure values. Enhanced right cardiac output might be responsible fully canadian family pharmacy. Another explanation may be pulmonary vasoconstriction caused by a local release of neurohumoral factors such as endothelin. In comparison to our result, a multicenter study of thrombolytic therapy found a zero reduction of pulmonary pressure 2 h after start of infusion. However, Uflacker et al. reported a considerable increase in pulmonary artery pressure after mechanical thrombectomy with the Amplatz catheter in three of four cases, which may support the theory of local vasoconstriction.
Within the 48-h follow-up interval, mean pulmonary artery pressure showed a significant decrease, which is again an effect of fragmentation in concert with medical (or intrinsic) thrombolysis.
Development of Pao2 and Paco2 were insignificant during fragmentation as well as in the 48-h follow-up, which might in part be due to different degrees of O, respirator concentrations used.
The different venous approaches did not impair placement and rotation function of the fragmentation catheter. Manual rotation proved to be sufficient for embolus break-up and obviated the need of the motor unit used in experimental testing, with the advantages of a direct tactile response and better visual correlation of the pigtail movement under fluoroscopic observation. The technical problems that occurred in this study were considered for design improvements for a new catheter version for the phase II study. An important feature is the increase in pigtail diameter and shaft size, which seems to be necessary for mechanical destabilization of large emboli in enlarged central arteries, and might improve the fragmentation results of the present study.

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