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

Il trattamento ibrido, meccanico e farmacologico, nell’embolia polmonare massiva con il semplice catetere angiografico

La radiologia medica volume 112, pages 837–849 (2007)Cite this article

Abstract

Purpose

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.

Materials and methods

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.

Results

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.

Conclusions

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.

Riassunto

Obiettivo

L’embolia polmonare massiva è un grave quadro clinico, con ipotensione sistemica e shock, che necessita di un pronto intervento terapeutico.

Riportiamo la nostra sistematica esperienza di trattamento ibrido: alla frammentazione meccanica dell’embolo con il catetere angiografico abbiamo associato, nei giorni successivi, la terapia fibrinolitica.

Materiali e metodi

Nel periodo 1999–2005, con il solo trattamento ibrido, sono stati trattati 164 pazienti con una diagnosi di embolia polmonare massiva. La procedura interventistica è stata effettuata direttamente con lo stesso catetere angiografico, sia per la terapia meccanica, che per l’infusione del farmaco fibrinolitico nei giorni successivi (24–72 ore). La valutazione dei risultati immediati veniva effettuata sulla base delle variazioni della pressione polmonare media.

Risultati

Sulla base dei risultati ottenuti dopo il solo passaggio del catetere angiografico, abbiamo registrato 4 tipi di comportamenti emodinamici. La frammentazione meccanica è stata effettuata con un solo passaggio del catetere angiografico in 61 (41,4%) pazienti e la pressione polmonare media è scesa rapidamente al di sotto del valore di 30 mmHg. In altri 38 (23,1%) casi si è reso necessario ricorrere a due passaggi per raggiungere lo stesso risultato; in 32 pazienti (19,5%) si è dovuto ricorrere a più di 3 passaggi. Negli ultimi 26 (15,8%), nonostante l’effettuazione di oltre 6 passaggi, la pressione polmonare media non è mai scesa sotto i 35 mmHg. In questo gruppo di pazienti si sono registrati gli unici due decessi della nostra esperienza.

Conclusioni

La frammentazione meccanica con il semplice catetere angiografico si è dimostrata valida e sicura per imprimere un brusco miglioramento delle pressioni polmonari e del generale stato clinico del paziente, mobilizzando l’embolo polmonare dalla sua iniziale sede centrale.

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Affiliations

  1. U.O.C. Radiologia Vascolare ed Interventistica, Az. Ospedaliera “S. Camillo-Forlanini”, Via F. Algarotti 8, I-00137, Roma, Italy

    S. Pieri & P. Agresti

Authors
  1. S. Pieri
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  2. P. Agresti
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Correspondence to S. Pieri.

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Pieri, S., Agresti, P. Hybrid treatment with angiographic catheter in massive pulmonary embolism: mechanical fragmentation and fibrinolysis. Radiol med 112, 837–849 (2007). https://doi.org/10.1007/s11547-007-0191-z

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  • DOI: https://doi.org/10.1007/s11547-007-0191-z

Key words

  • Pulmonary embolism
  • Mechanical fragmentation
  • Pharmacological thrombolysis

Parole chiave

  • Embolia polmonare
  • Frammentazione meccanica
  • Trombolisi farmacologica