Acute-on-Chronic Massive Pulmonary Embolism Treated With 3-Loop Snare

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A 70-year-old man presented with acute massive pulmonary embolism (PE). His clinical condition deteriorated despite regular heparin and thrombolytic agent treatment, and he eventually developed cardiogenic shock. A thrombus originating from the inferior vena cava was detected and acute-on-chronic embolization resulted, with an unusual clinical course. Aggressive catheter thrombectomy with pigtail rotation failed to fragment the organized thrombus, but it was successfully removed by a 3-loop snare device combined with guiding catheter under percutaneous cardiopulmonary support. (Circ J 2008; 72: 1909 - 1913)