Massive pulmonary embolism: percutaneous emergency treatment by pigtail rotation catheter
Thomas Schmitz-Rode, MDa,
Uwe Janssens, MDb,
Stephan H. Duda, MDc,
Christiane M. Erley, MDd and
Rolf W. Günther, MDa
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
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Figure 1 Pigtail fragmentation catheter (with underlying rotated pigtail loop indicating a 180° turn) with a special tip configuration for embolus fragmentation; the guide wire is exiting an oval side hole distal to a radiopaque marker and serves as a directing axis crossing the embolic occlusion. During manual catheter rotation, the pigtail tip is slowly advanced and withdrawn within the occlusion over the fixed guide wire. The embolus is fragmented by mechanical action of the rotating pigtail.
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Figure 2 Sixty-six-year-old male patient with deep vein thrombosis after coronary angiography. (A and B) Prefragmentation pulmonary angiogram shows emboli in the right intermediate and upper lobe arteries (arrowheads), and in the left intermediate artery (arrowheads) with occlusion of the lower lobe artery. Shock index 1.10, mean pulmonary artery pressure 30 mm Hg. (C and D) After bilateral embolus fragmentation: partial recanalization, more pronounced on the right side. Shock index 0.59, mean pulmonary artery pressure 15 mm Hg. Intraluminal fragment (arrowhead) is in a segmental artery of the left lower lobe.
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