Hybrid treatment with angiographic catheter in massive pulmonary embolism: mechanical fragmentation and fibrinolysis

Abstract

Massive pulmonary embolism is a severe clinical condition that requires prompt therapeutic intervention. We report our experience with a hybrid treatment involving systematic fragmentation of the embolus with an angiographic catheter associated with fibrinolytic therapy over the following days. From 1999-2005 we treated 164 patients with massive pulmonary embolism. We used the same angiographic catheter for mechanical fragmentation and for administration of the fibrinolytic agent (24-72 h). Results were assessed on the basis of changes in mean pulmonary artery pressure. After fragmentation with the angiographic catheter, we observed four types of haemodynamic behaviour: in 61 patients (41.4%), mean pulmonary artery pressure fell rapidly below 30 mmHg; in 38 patients (23.1%), two passes were required to achieve the same result; in 32 patients (19.5%) three passes were required. In the remaining 26 patients (15.8%), at no time did the mean pulmonary artery pressure fall below 35 mmHg. The only two deaths occurred in this last group. Mechanical fragmentation with the angiographic catheter and administration of fibrinolytic agents effectively brought about a rapid improvement in patients' clinical status by moving the embolus towards the periphery.