Treatment of high- and intermediate-risk pulmonary embolism using the AngioJet percutaneous mechanical thrombectomy system in patients with contraindications for thrombolytic treatment - a pilot study

Abstract

Introduction: Intravenous thrombolysis is the treatment of choice in patients presenting with high- and intermediate-risk pulmonary embolism. The role of percutaneous mechanical pulmonary thrombectomy (PMPT) is not fully established, although selected patients can be managed with this method.

Aim: This open-label single-centre prospective pilot study was aimed at assessing the feasibility of PMPT for the treatment of severe pulmonary embolism in a Polish hospital. We also evaluated the safety and efficacy of such management.

Material and methods: We managed 7 patients, aged 52.7 ±16.6 years, presenting with high- and intermediate-risk pulmonary embolism (4 patients with class 5 and one patient with class 4 of the Pulmonary Embolism Severity Index), with occlusion of at least 2 lobar arteries and contraindications for thrombolysis. Percutaneous mechanical pulmonary thrombectomy was performed using the AngioJet system.

Results: It was possible to introduce the thrombectomy system to the pulmonary arteries in all patients. The procedure was successful in 6 patients (technical success rate: 85.7%). Two (28.6%) patients died during the hospital stay, one patient with unsuccessful thrombectomy and the other due to pneumonia. In all survivors control echocardiography demonstrated normalised function of the right ventricle. Also, dyspnoea disappeared and blood gas parameters normalised. There was no recurrent thromboembolism during 3-14 months of follow-up.

Conclusions: In the Polish setting, in selected patients, management of high- and intermediate-risk pulmonary embolism with PMPT is technically feasible. Such treatment is relatively safe and effective. It can be an alternative to standard management, especially in patients with contraindications for fibrinolysis or surgical embolectomy.

Keywords: mechanical thrombectomy system; pulmonary artery; pulmonary embolism; thromboembolic disease.

Figure 1

Algorithm of management of patients with pulmonary embolism in our hospital

Figure 2

Flow chart of patients

Figure 3

Result of thrombectomy in patient with right-sided pulmonary embolism: A – initial image – occlusion of the middle and inferior lobar arteries, and also partial occlusion of the superior lobar artery, B – AngioJet system introduced to the pulmonary artery, C – final result

Figure 4

Result of thrombectomy in patient with bilateral occlusion of pulmonary arteries: A – initial image: occlusion of the left superior and inferior lobar arteries, B – after thrombectomy of the inferior lobar arteries of the left lung, C – occlusion of the superior, middle and inferior lobar arteries of the right lung, D – recanalisation of the inferior, E – superior lobar arteries