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Acute Massive and Submassive Pulmonary Embolism: Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis

  • Massimo Pieraccini
  • Susanna Guerrini
  • Edoardo Laiolo
  • Alessio Puliti
  • Giandomenico Roviello
  • Leonardo Misuraca
  • Genni Spargi
  • Ugo Limbruno
  • Mauro Breggia
  • Morando Grechi
Clinical Investigation
Part of the following topical collections:
  1. Arterial Interventions

Abstract

Purpose

The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis.

Materials and Methods

Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score.

Results

Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO2), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence.

Conclusion

The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.

Keywords

Pulmonary embolism (PE) Catheter-directed treatment (CDT) Thrombolysis Computed tomography angiography (CTA) Submassive pulmonary embolism Massive pulmonary embolism 

Notes

Acknowledgements

English language editing and proofreading were by Angelica Tavanti, freelance translator, and Monique Camarra, English instructor, University of Siena.

Compliance with Ethical Standards

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Massimo Pieraccini
    • 1
  • Susanna Guerrini
    • 2
  • Edoardo Laiolo
    • 1
  • Alessio Puliti
    • 1
  • Giandomenico Roviello
    • 3
  • Leonardo Misuraca
    • 4
  • Genni Spargi
    • 5
  • Ugo Limbruno
    • 4
  • Mauro Breggia
    • 6
  • Morando Grechi
    • 1
    • 2
  1. 1.Department of Diagnostic Imaging and Laboratory Medicine, Vascular and Interventional Radiology Unit, Azienda USL Toscana SUD-ESTMisericordia HospitalGrossetoItaly
  2. 2.Department of Diagnostic Imaging and Laboratory Medicine, Diagnostic Imaging Unit, Azienda USL Toscana SUD-ESTMisericordia HospitalGrossetoItaly
  3. 3.Division of Medical Oncology, Department of Onco-Hematology, IRCCS-CROBReferral Cancer Center of BasilicataRionero, VultureItaly
  4. 4.Cardioneurovascular Department, Cardiology Unit, Azienda USL Toscana SUD-ESTMisericordia HospitalGrossetoItaly
  5. 5.Emergency Department, Intensive Care Unit, Azienda USL Toscana SUD-ESTMisericordia HospitalGrossetoItaly
  6. 6.Emergency Department, Emergency Unit, Azienda USL Toscana SUD-ESTMisericordia HospitalGrossetoItaly

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