01 March 2017 by Cihangir Kaymaz

Single-center experience on rheolytic thrombectomy in patients with pulmonary embolism at high risk or intermediate-high risk

Background and aims

Rheolytic thrombectomy (RT) has been used as a percutaneous technology  providing a high efficacy with a reduced  bleeding risk in patients (pts) with pulmonary embolism (PE). In this study we aimed to present our single-center results on RT in pts with PE at intermediate-high and high risk (IHR, HR).

Methods

Our study was based on the retrospective analysis of the overall 26 pts (female 14, age  60±18.2 years) with documented PE who underwent RT using a dedicated  system. The systematic work-up including multidetector computed tomography (MDCT), Echo, biomarkers, and PE severity index and its simplified version (PESI,sPESI) were performed in all pts, and Qanadli score (QS) was used as the MDCT measure of the thrombotic burden in the pulmonary arteries (PA).

Results

The IHR and HR were noted in 22 and four pts, respectively. Clinical, echo and MDCT measures and median time delay from symptoms to treatment were comparable between UFT and RT groups (p>0.05). Failure in the placement of catheters was experienced in one out of 27 RT attempts. Intra-PA infusion of adjuvant tissue-plasminogen activator (t-PA) was needed in only five pts (19.2 %) treated with RT, and t-PA dosage was 14,6±5,1 mg. Regardless the baseline risk status, RT resulted in dramatic improvements in tricuspid annular planary systolic excursion (TAPSE) and tissue systolic velocity (St), PA systolic and mean pressures, QS, right to left ventricle diameter ratio (RV/LV) and right to left atrial diameter ratio (RA/LA), and diameters of main, right and left PA (p<0.001 for all). The RT induced short-term bradicardias or conduction disturbances during system activation, and a gross hemoglobinuria for one or two days in all pts. Non-fatal major bleeding was not observed whereas death from treatment failure was documented in two (7.6%) pts. Post-discharge PE-related morbidity and mortality was not documented during follow-up period for median 310 (68-983) days.

Conclusions

Irrespective of the baseline risk status, RT facilitates the thrombolysis, recovery of pulmonary hemodynamics and right heart functions with low rates of complications in pts with PE.

Key Contributors

Cihangir Kaymaz, Ozgür Y Akbal, FatihYilmaz,Ibrahim H Tanboga, Aykun Hakgor, Canan Elif Yildiz, Sevim Turkday, Hacer CerenTokgoz, Durmuş Demir, Seda Tanyeri, Nihal Ozdemir Kartal KosuyoluHeartEducationandResearchHospital, Istanbul, Turkey,İH Tanboğa (AtaturkUniversity, CardiologyandBiostatistics, Erzurum, Turkey)


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