Acute massive pulmonary thromboembolism : A combined approach with mechanical fragmentation using a modified rotating pigtail catheter, local fibrinolysis, and manual thrombo-aspiration

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Purpose : To evaluate the efficacy and safety of mechanical fragmentation, local tnrombolysis and manual tnrombo-aspiration in the treatment of acute massive pulmonary thromboembolism with hemodynamic impairment. Materials and methods : Within 3 years, 20 hemodynamically impairment patients were treated with thrombus fragmentation by mechanical action of modified rotating pigtail catheter. After embolus fragmentation, all patients received intrapulmonary injection of recombinant human-tissue plasminogen activator (rt PA), followed by manual thrombo-aspiration using a large lumen PTCA guiding catheter. Results : All patients survived and their clinical status improved. Angiography in all patients post treatment demonstrated improvement of the pulmonary perfusion. Mean pulmonary arterial pressure decreased statistically. Mean treatment time was 131 min. Conclusion : Mechanical fragmentation by rotating pigtail catheter with local fibrinolysis and manual thrombo-aspiration provided a rapid and safe improvement of the hemodynamic situation in acute massive pulmonary thromboembolism.