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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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2/2018
vol. 13
 
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abstract:
Original paper

Treatment of high- and intermediate-risk pulmonary embolism using the AngioJet percutaneous mechanical thrombectomy system in patients with contraindications for thrombolytic treatment – a pilot study

Paweł Latacz
,
Marian Simka
,
Pawel Brzegowy
,
Wojciech Serednicki
,
Ewa Konduracka
,
Wojciech Mrowiecki
,
Agnieszka Słowik
,
Bartłomiej Łasocha
,
Tomasz Mrowiecki
,
Tadeusz Popiela

Videosurgery Miniinv 2018; 13 (2): 233–242
DOI: https://doi.org/10.5114/wiitm.2018.75848
Online publish date: 2018/05/16
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Introduction
Intravenous thrombolysis is the treatment of choice in patients presenting with high- and intermediate-risk pulmonary embolism. The role of percutaneous mechanical pulmonary thrombectomy (PMPT) is not fully established, although selected patients can be managed with this method.

Aim
This open-label single-centre prospective pilot study was aimed at assessing the feasibility of PMPT for the treatment of severe pulmonary embolism in a Polish hospital. We also evaluated the safety and efficacy of such management.

Material and methods
We managed 7 patients, aged 52.7 ±16.6 years, presenting with high- and intermediate-risk pulmonary embolism (4 patients with class 5 and one patient with class 4 of the Pulmonary Embolism Severity Index), with occlusion of at least 2 lobar arteries and contraindications for thrombolysis. Percutaneous mechanical pulmonary thrombectomy was performed using the AngioJet system.

Results
It was possible to introduce the thrombectomy system to the pulmonary arteries in all patients. The procedure was successful in 6 patients (technical success rate: 85.7%). Two (28.6%) patients died during the hospital stay, one patient with unsuccessful thrombectomy and the other due to pneumonia. In all survivors control echocardiography demonstrated normalised function of the right ventricle. Also, dyspnoea disappeared and blood gas parameters normalised. There was no recurrent thromboembolism during 3–14 months of follow-up.

Conclusions
In the Polish setting, in selected patients, management of high- and intermediate-risk pulmonary embolism with PMPT is technically feasible. Such treatment is relatively safe and effective. It can be an alternative to standard management, especially in patients with contraindications for fibrinolysis or surgical embolectomy.

keywords:

thromboembolic disease, pulmonary embolism, mechanical thrombectomy system, pulmonary artery
  
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