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Temporary Pulmonary Stent Placement as Emergency Treatment of Pulmonary Embolism

First Experimental Evaluation

Thomas Schmitz-Rode, MD^_*,_*, Rajeev Verma, MD, Joachim G. Pfeffer^_*, Ralf-Dieter Hilgers, PhD and Rolf W. Günther, MD

^_* Department of Applied Medical Engineering, Helmholtz Institute
Department of Diagnostic Radiology
Institute for Medical Statistics, RWTH Aachen University and University Hospital, Aachen, Germany

View larger version (82K): [in a new window]   Figure 1 Phases of deployment of a removable pulmonary stent for emergency treatment of acute massive pulmonary embolism, made from self-expanding woven shape-memory wire (maximum expanded diameter 20 mm). The attached guidewire (arrow, bottom panel) facilitates removal by withdrawal into the 9.5-F sheath.

View larger version (98K): [in a new window]   Figure 2 Pulmonary angiograms obtained in the frontal (A to D) and oblique (E) views in 1 sheep. (A) Normal baseline pulmonary angiogram. (B) Angiogram obtained after thrombus injection shows massive pulmonary embolism of the left main pulmonary artery with complete occlusion of the depending left pulmonary arteries (arrows). (C) Fluoroscopy image after placement of the pulmonary stent (arrows) attached to the wire. (D, E) Frontal and left anterior oblique angiograms obtained by contrast injection through the stent delivery sheath after left-sided stent deployment shows considerable recanalization and improved perfusion of the left upper and lower lobes. Residual stenosis due to compressed embolus (arrow in E).

View larger version (7K): [in a new window]   Figure 3 Graphs show (A) heart rate, (B) mean pulmonary artery pressure, and (C) mean aortic pressure at baseline, after embolus injection, and after stent placement in 7 sheep. The average of the parameters improved significantly after stent placement.