Interventional Radiology for the Treatment of Acute Massive Pulmonary Thromboembolism

Abstract

Acute massive pulmonary thromboembolism is a life-threatening condition with a high mortality rate due to acute right ventricular failure and cardiogenic shock. Anticoagulation is the most traditional treatment for pulmonary thromboembolism, but may not be sufficient for massive thromboemboli. Systemic thrombolytic therapy and surgical embolectomy are the usual therapeutic options in this situation. Catheter directed thrombolysis and catheter embolectomy are now available to treat the most severe cases of massive pulmonary thromboembolism. There currently are 3 categories of catheter-tip embolectomy for removing or fragmenting pulmonary thromboemboli: (1) aspiration thrombectomy, (2) fragmentation, and (3) rheolytic thrombectomy. The success of these techniques depends on a thorough understanding of the mechanism of each devices and familiarity with the relevant catheterization techniques. Although no controlled clinical trials are available, data from cohort studies indicate that the clinical outcomes after surgical and catheter embolectomy may be comparable. We hereby present a review of currently available equipment and techniques, and describe our work with hybrid treatment using a combination of mechanical fragmentation, local fibrinolysis and clot aspiration.