Endovascular Therapy for the Treatment of Acute Massive Pulmonary Thromboembolism

Abstract

Endovascular therapy is now available to treat the most severe cases of acute massive pulmonary thromboembolism with a high mortality rate. It consists of catheter directed thrombolysis and catheter-tip embolectomy, and the goal of these techniques is rapid central clot debulking to relieve life-threatening heart strain and immediately improve pulmonary circulation. Although no controlled clinical trials are available, data from cohort studies indicate that the clinical outcomes after surgical and catheter-tip embolectomy may be comparable. The success of these techniques depends on a deep understanding of each devices and relevant catheterization techniques. This article reviews the current approach to endovascular therapy for acute massive pulmonary thromboembolism, and describes our study with hybrid treatment using a combination of local fibrinolysis, mechanical fragmentation, and clot aspiration.