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CardioVascular and Interventional Radiology

, Volume 20, Issue 5, pp 364–368 | Cite as

Massive Pulmonary Embolism: Treatment with Thrombus Fragmentation and Local Fibrinolysis with Recombinant Human-Tissue Plasminogen Activator

  • Klaus Wilhelm  Stock
  • Augustinus Ludwig  Jacob
  • Karl Jakob  Schnabel
  • Georg  Bongartz
  • Wolfgang  Steinbrich
Article

Abstract

Purpose: To report the results of thrombus fragmentation in combination with local fibrinolysis using recombinant human-tissue plasminogen activator (rtPA) in patients with massive pulmonary embolism.

Methods: Five patients with massive pulmonary embolism were treated with thrombus fragmentation followed by intrapulmonary injection of rtPA. Clot fragmentation was performed with a guidewire, angiographic catheter, and balloon catheter. Three patients had undergone recent surgery; one of them received a reduced dosage of rtPA.

Results: All patients survived and showed clinical improvement with a resultant significant (p < 0.05) decrease in the pulmonary blood pressure (mean systolic pulmonary blood pressure before treatment, 49 mmHg; 4 hr after treatment, 28 mmHg). Angiographic follow-up in three patients revealed a decrease in thrombus material and an increase in pulmonary perfusion. Two patients developed retroperitoneal hematomas requiring transfusion.

Conclusion: Clot fragmentation and local fibrinolysis with rtPA was an effective therapy for massive pulmonary embolism. Bleeding at the puncture site was a frequent complication.

Key words: Embolism, pulmonary—Fragmentation, mechanical—Thrombolysis—Interventional procedures 

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Copyright information

© Springer-Verlag New York Inc. 1997

Authors and Affiliations

  • Klaus Wilhelm  Stock
    • 1
  • Augustinus Ludwig  Jacob
    • 1
  • Karl Jakob  Schnabel
    • 1
  • Georg  Bongartz
    • 1
  • Wolfgang  Steinbrich
    • 1
  1. 1.Department of Radiology, University Hospital of Basel, Petersgraben 4, CH-4031 Basel, SwitzerlandCH

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