Ces radiol. 2007, 61(2):162-166

Percutaneous mechanical fragmentation of emboli in the pulmonary arteryOriginal article

Antonín Krajina¹, Miroslav Lojík¹, Vendelín Chovanec¹, Jan Raupach¹, Miroslav Solař², Jitka Schreiberová³, Jan Baštecký²

¹ Radiologická klinika FN, Hradec Králové

² I. interní klinika FN, Hradec Králové

³ Klinika anesteziologie, resuscitace a intenzivní medicíny FN, Hradec Králové

Aim: Mechanical fragmentation of pulmonary emboli was used to improve pulmonary perfusion after massive pulmonary embolization.

Method: Our retrospective study included 5 patients (4 women, 1 man) of mean age 67 years (range 52-80 years) with massive pulmonary embolization. Three of these patients underwent extensive surgery on the same day, resp. 2 and 10 days before: pneumonectomy for carcinoma, nephrectomy for renal cell carcinoma with extirpation of a mixed thrombus from the inferior vena cava and reoperation for total hip replacement. Cardiopulmonary resuscitation was required in all of them, all patients developed cardiogenic shock. The patients were intubated, artificially ventilated and immediately transferred with inotropic support to the catheterization room. Flexible sheath (9F) was placed in the pulmonary artery. Fragmentation of pulmonary emboli was performed using manual rotation of the catheters. There were 19 to 40 mg of recombinant tissue plasminogen activator given locally in 3 cases to accelerate unsuccessful recanalization.

Results: Two patients (40 %) survived, underwent further therapy and were discharged home. Three patients (60 %) died due to irreversible cardiogenic shock (two of them during the procedure).

Conclusion: Early diagnosis of massive pulmonary embolism, even based only on clinical symptoms, and urgent catheterization of pulmonary artery with fragmentation of emboli can increase blood flow in the pulmonary artery and be life saving procedure in selected cases with cardiac arrest.

Keywords: interventional radiology, pulmonary embolism, cardiac arrest, shock

Accepted: April 15, 2007; Published: June 1, 2007  Show citation