|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2000; 36:375-380 © 2000 by the American College of Cardiology Foundation |
a Department of Diagnostic Radiology, University of Technology, Aachen, Germany
b Department of Cardiology, University of Technology, Aachen, Germany
c Department of Diagnostic Radiology, University of Tübingen, Tübingen, Germany
d Department of Cardiology, University of Tübingen, Tübingen, Germany
Manuscript received October 25, 1999; revised manuscript received January 26, 2000, accepted March 29, 2000.
Reprint requests and correspondence: Prof. T. Schmitz-Rode, Department Diagnostic Radiology, University of Technology, Universitätsklinikum, Pauwelsstrasse 30, D-52057 Aachen, Germany
smiro{at}rad.rwth-aachen.de
Objectives
This study was designed to assess the feasibility, efficacy and safety of mechanical fragmentation of pulmonary emboli using a new rotational pigtail catheter system.
BACKGROUND
Acute massive pulmonary embolism associated with right ventricular dysfunction is frequently lethal, despite high-dose thrombolytic therapy. Adjunctive catheter fragmentation may prevent a fatal outcome.
METHODS
In 20 patients (age 58.9 ± 10.5 years) with severe hemodynamic impairment, massive pulmonary emboli were fragmented by mechanical action of the rotating pigtail. Fifteen patients received thrombolysis after embolus fragmentation or no thrombolysis at all (noninterference group).
RESULTS
Prefragmentation pulmonary arterial occlusion was 68.6 ± 11.3% for both lungs. Pulmonary placement and navigation of the fragmentation catheter was easy and rapid. Fragmentation time was 17 ± 8 min. The noninterference group showed a decrease pre- to postfragmentation of shock index from 1.28 ± 0.53 to 0.95 ± 0.38 (p = 0.011), mean pulmonary artery pressure from 31 ± 5.7 to 28 ± 7.5 mm Hg (p = 0.02) and a recanalization by fragmentation of 32.9 ± 11.8% (mean angiographic score per treated lung from 7.4 to 5.0). Overall mortality was 20%.
CONCLUSIONS
Fragmentation by pigtail rotation catheter provided for a rapid and safe improvement of the hemodynamic situation and an average recanalization of about one-third of the pulmonary embolic occlusion. The method appears useful especially in high-risk patients threatened by right ventricular failure, to accelerate thrombolysis, and as a minimal-invasive alternative to surgical embolectomy.
This article has been cited by other articles:
|
|
 |
|
  K. E. A. Burns and A. McLaren A critical review of thromboembolic complications associated with central venous catheters: [Une synthese critique des complications thromboemboliques associees aux catheters veineux centraux] Can J Anesth, August 1, 2008; 55(8): 532 - 541. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Eid-Lidt, J. Gaspar, J. Sandoval, F. D. de los Santos, T. Pulido, H. Gonzalez Pacheco, and C. Martinez-Sanchez Combined Clot Fragmentation and Aspiration in Patients With Acute Pulmonary Embolism Chest, July 1, 2008; 134(1): 54 - 60. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon, S. R. Kahn, G. Agnelli, S. Goldhaber, G. E. Raskob, and A. J. Comerota Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 454S - 545S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Kucher Catheter Embolectomy for Acute Pulmonary Embolism Chest, August 1, 2007; 132(2): 657 - 663. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Schmitz-Rode, R. Verma, J. G. Pfeffer, R.-D. Hilgers, and R. W. Gunther Temporary Pulmonary Stent Placement as Emergency Treatment of Pulmonary Embolism: First Experimental Evaluation J. Am. Coll. Cardiol., August 15, 2006; 48(4): 812 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Kucher, S. Windecker, Y. Banz, T. Schmitz-Rode, D. Mettler, B. Meier, and O. M. Hess Percutaneous Catheter Thrombectomy Device for Acute Pulmonary Embolism: In Vitro and in Vivo Testing Radiology, September 1, 2005; 236(3): 852 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Kucher and S. Z. Goldhaber Management of Massive Pulmonary Embolism Circulation, July 12, 2005; 112(2): e28 - e32. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Tajima, S. Murata, T. Kumazaki, K. Nakazawa, Y. Abe, Y. Komada, P. Niggemann, M. Takayama, K. Tanaka, and T. Takano Hybrid Treatment of Acute Massive Pulmonary Thromboembolism: Mechanical Fragmentation with a Modified Rotating Pigtail Catheter, Local Fibrinolytic Therapy, and Clot Aspiration Followed by Systemic Fibrinolytic Therapy Am. J. Roentgenol., September 1, 2004; 183(3): 589 - 595. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Buller, G. Agnelli, R. D. Hull, T. M. Hyers, M. H. Prins, and G. E. Raskob Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 401S - 428S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Tajima, S. Murata, T. Kumazaki, K. Ichikawa, T. Tajiri, and Y. Yamamoto Successful Interventional Treatment of Acute Internal Jugular Vein Thrombosis Am. J. Roentgenol., February 1, 2004; 182(2): 467 - 469. [Full Text] [PDF]
|
|
|
|
 |
|
 British Thoracic Society guidelines for the management of suspected acute pulmonary embolism Thorax, June 1, 2003; 58(6): 470 - 483. [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Jones, J. A. Watts, J. P. Debelak, L. R. Thornton, J. G. Younger, and J. A. Kline Inhibition of prostaglandin synthesis during polystyrene microsphere-induced pulmonary embolism in the rat Am J Physiol Lung Cell Mol Physiol, June 1, 2003; 284(6): L1072 - L1081. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Kucher, G. Printzen, and S. Z. Goldhaber Prognostic Role of Brain Natriuretic Peptide in Acute Pulmonary Embolism Circulation, May 27, 2003; 107(20): 2545 - 2547. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Pruszczyk, R Pacho, M Ciurzynski, M Kurzyna, B Burakowska, W Tomkowski, A Bochowicz, and A Torbicki Short term clinical outcome of acute saddle pulmonary embolism Heart, March 1, 2003; 89(3): 335 - 336. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Kucher, C.M. Luder, T. Dornhofer, S. Windecker, B. Meier, and O.M. Hess Novel management strategy for patients with suspected pulmonary embolism Eur. Heart J., February 2, 2003; 24(4): 366 - 376. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. F. Baker Jr Thrombolytic Therapy Clinical and Applied Thrombosis/Hemostasis, October 1, 2002; 8(4): 291 - 314. [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
