System thrombolysis combined with percutaneous catheter fragmentation and thrombectomy in acute massive pulmonary embolism

Objective: To evaluate the safety and clinical efficacy of system thrombolysis combined with percutaneous catheter thrombus fragmentation and thrombectomy for acute massive pulmonary embolism. Methods: Ninteen patients with acute massive pulmonary embolism were treated with IVC filter placement, percutaneous catheter thrombus fragmentation and system thrombolysis combined with anticoangulation using low-molecular-weight heparin. Four of 19 patients underwent adjuvant Straub Rotarex catheter thrombectomy. Results: Twenty-one procedures were performed in 19 patients. Improvement of pulmonary artery patency and initial relief of symptoms immediately occurred in 18 of 19 patients after interventional therapy. The oxygen saturation increased from 86% to 97%. Pulmonary artery pressure decreased from 33 ± 5 mm Hg(1 mm Hg =0.133 kPa)to 25 ± 5 mmHg after interventional therapy (t=13.2, P<0.01). One patient with bilateral pulmonary, artery trunk massive thrombus failed to be treated with interventional therapy and system thrombolysis, and died during the procedure of surgical thromboectomy. Technical success was achieved in 4 patients with Straub Rotarex thromboectomy and no complication occurred. Conclusion: System thrombolysis combined with percutaneous catheter fragmentation and thrombectomy was effective and safe in patients with acute massive pulmonary embolism. (authors)