Endovascular thrombectomy with the AngioJet System for the treatment of intermediate-risk acute pulmonary embolism: a case report of two patients

Introduction

Acute pulmonary embolism (PE) is one of the leading causes of death and ranks third, after myocardial infarction and cerebral stroke, among fatal hospital-related cardiovascular events [1–3]. Mortality associated with PE can be lowered by early treatments aimed at restoring patency of occluded pulmonary arteries (PAs). Although systemic thrombolysis remains the recommended management of PE [4], recent advances in endovascular techniques, especially of rheolytic thrombectomy, suggest that the endovascular approach can represent an alternative therapeutic strategy [5–9]. Here we describe endovascular treatment of two patients with acute PE. We used the AngioJet (Boston Scientific, Natick, MA, USA) rheolytic thrombectomy system. According to the available information, including personal communications, these were the second and third applications of this system in Poland for acute PE, and the first successful ones.

Case reports

Case 1. A 31-year-old man, without cardiovascular risk factors and no deep venous thrombosis on ultrasound examination, was admitted to our hospital due to a 3-day history of progressive dyspnea. There were electrocardiographic (ECG) features of overload of the right ventricle. Echocardiography demonstrated signs of right ventricle overload and increased pulmonary arterial pressure. Computed tomography (CT) angiography revealed saddle PE, with partial occlusion of the pulmonary trunk, subtotal occlusion of the right PA and all its major branches, and partial occlusions of the branches of the left PA. Initially the patient received heparin, still with only a slight clinical improvement. Considering his severe clinical status, including profound hypoxemia, we decided to perform thrombectomy of the occluded PAs. The patient was consulted by a cardiovascular surgeon, who – taking into account the patient’s clinical condition – instead of surgical thrombectomy recommended an endovascular approach.
Case 2. A 55-year-old woman, after chemo- and radiotherapy for small cell carcinoma of the right lung and clinical remission of the cancer, was transferred from the oncological department because of several-day history of increasing dyspnea. This patient developed PE despite adequate anticoagulation. Similarly to the previous case, there were ECG and echocardiographic signs of right ventricle overload and no sonographic features of deep venous thrombosis. CT angiography showed subtotal embolic occlusions...


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