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Case Reports
. 2020;80(3):285-288.

[Mechanical fragmentation and catheter-guided thrombolysis in intermediate risk pulmonary embolism]

[Article in Spanish]
Pablo E Sarmiento  1 , Nicolás Zaderenko  2 , Roberto M A Colque  2 , Florencia Melgarejo Otarola  2 , Guillermo Pacheco  2 , Fernando J Daghero  2 , Miguel A Tibaldi  2 , Eduardo Moreyra H  2
Affiliations
  • PMID: 32442944
Free article
Case Reports

[Mechanical fragmentation and catheter-guided thrombolysis in intermediate risk pulmonary embolism]

[Article in Spanish]
Pablo E Sarmiento et al. Medicina (B Aires). 2020.
Free article

Abstract
in English, Spanish

Acute pulmonary thromboembolism remains a significant cause of morbidity and mortality worldwide. Its diagnosis, risk stratification and early treatment are essential. The mainstay of treatment is anticoagulation. In patients with low cardiovascular risk, the prognosis is excellent and the treatment consists only of the administration of anticoagulants. Due to the poor prognosis of patients with high risk (hemodynamic decompensation), the approach is more aggressive using systemic thrombolytics, which reduce mortality but increase the risk of major hemorrhagic complications. In the intermediate-risk patients (evidence of right ventricular failure, without hemodynamic decompensation), the risk-benefit relationship of thrombolytic treatment is more balanced, so the choice is controversial. Mechanical fragmentation with catheter-directed thrombolysis is an alternative with potential benefits. We present two cases of intermediate-risk acute pulmonary thromboembolism to whom mechanical fragmentation and catheter-directed thrombolysis was applied.

La tromboembolia pulmonar aguda (TEPA) sigue siendo una importante causa de morbilidad y mortalidad a nivel mundial. Su diagnóstico, estratificación de riesgo y tratamiento precoz son fundamentales, siendo su pilar la anticoagulación. En pacientes de bajo riesgo cardiovascular, el pronóstico es excelente y solo basta con la administración de anticoagulantes. No obstante, debido al pobre pronóstico de los pacientes con riesgo elevado (descompensación hemodinámica), el enfoque terapéutico es más agresivo, utilizándose trombolíticos sistémicos que disminuyen la mortalidad pero incrementan el riesgo de complicaciones hemorrágicas mayores. En el TEPA de riesgo intermedio (evidencia de falla de ventrículo derecho, sin descompensación hemodinámica), la relación riesgo-beneficio del tratamiento con trombolíticos es más equilibrada por lo que la decisión es controvertida. La fragmentación mecánica con trombólisis dirigida por catéter es una alternativa con potenciales beneficios. Presentamos dos casos de TEPA de riesgo intermedio, en los que se realizó fragmentación mecánica y trombólisis dirigida por catéter.

Keywords: acute pulmonary thromboembolism; catheter-directed thrombolysis; intermediate risk.

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