Rheolytic thrombectomy in patient with acute pulmonary embolism, heparin-induced thrombocytopenia and recent stoke. When percutaneous treatment is the only therapeutic alternative.

Abstract

To report the combined use of rheolytic thrombectomy (RT) and inferior vena cava (IVC) filter placement in the setting of acute pulmonary embolism (PE), heparin-induced thrombocytopenia (HIT) type II (HIT-II) and recent ischemic stroke. A 66-year-old man with an HIT-II and recent ischemic stroke was referred to our institution from a secondary regional center for acute PE and left deep vein thrombosis (DVT), confirmed at chest computed tomography (CT) and lower limb ultrasound, respectively. RT was attempted because intravenous heparin anticoagulation was contraindicated by the patient's medical history while recent ischemic stroke contraindicated thrombolysis. An Angiojet® catheter was used to perform RT. An IVC filter was placed after the procedure. The patient was discharged after 13 days and did very well, both at the 6- and 12-month follow-ups, with no recurrence of the venous thromboembolism. This case demonstrates the usefulness of RT in treating acute PE in clinically difficult scenarios, especially when thrombolytic therapy is contraindicated.