Nassiri N1*, Samuel Kogan S1, Truong H1, Huntress L1, Vagaonescu T2, Nagarsheth K1, Shafritz R1 and Rahimi S1
1Department of Surgery, Rutgers Robert Wood Johnson Medical School, USA
2Department of Medicine, Rutgers Robert Wood Johnson Medical School, USA
Purpose: In the current era of rapidly advancing catheter technology for treatment of acute pulmonary embolism, we present a simple yet effective technique for prompt resolution of right heart strain in a deteriorating patient with a submassive pulmonary embolism (SMPE).Methods: A 58-year old female with an acute SMPE (saddle and bilateral lobar PE with RV: LV ratio= 1.44; pulmonary artery systolic pressure 70 mmHg; BNP 10,624 pg/mL; peak troponin t level 0.33 ng/mL) was recommended to undergo prolonged catheter-directed thrombolytic infusion (EKOS Corp. Bothell, WA). Intraoperatively, she deteriorated hemodynamically with development of massive PE (MPE). A decision was made to forego prolonged thrombolytic infusion. Selective catheterization of main branch and bilateral lobar pulmonary arteries was performed with direct transcatheter infusion of a total of 20 mg of alteplase over a 15-minute period.Results: There was prompt improvement in mean PA pressures, right ventricular systolic function, and pressor requirements. Post-operative CTA and TTE confirmed resolution of saddle embolus and alleviation of right heart strain. Patient was discharged home on oral anticoagulation without supplemental oxygen requirements.Conclusion: Selective transcatheter pulmonary artery thrombolysis is a simple, safe, effective, and inexpensive alternative to systemic thrombolysis and prolonged thrombolytic infusion particularly in rapidly deteriorating patients with MPE and SMPE.
Pulmonary artery thrombolysis; Pulmonary embolism; Catheter technology
Nassiri N, Samuel Kogan S, Truong H, Huntress L, Vagaonescu T, Nagarsheth K, et al. Selective Lobar Pulmonary Artery Thrombolysis: A Simple and Effective Technique in the Era of Rapidly Advancing Catheter Technology. Clin Surg. 2016; 1: 1177.