Selective Lobar Pulmonary Artery Thrombolysis: A Simple and Effective Technique in the Era of Rapidly Advancing Catheter Technology

Nassiri N, Samuel Kogan S, Truong H, Huntress L, Vagaonescu T, Nagarsheth K, Shafritz R and Rahimi S

Department of Surgery, Rutgers Robert Wood Johnson Medical School, USA
Department of Medicine, Rutgers Robert Wood Johnson Medical School, USA

^*Correspondance to: Naiem Nassiri 

 PDF  Full Text DOI: 10.25107/2474-1647.1177

Abstract

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.

Keywords

Pulmonary artery thrombolysis; Pulmonary embolism; Catheter technology

Cite the article

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.