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. 2020;12(1):72-76.
doi: 10.17691/stm2020.12.1.09.

Endovascular Mechanical Thromboembolus Fragmentation in the Treatment of Critical Pulmonary Thromboembolism in Patients with Acute Hemorrhagic Stroke

A M Homenko  1 , E A Kusmenko  2 , V V Pichugin  3 , A P Medvedev  4
Affiliations

Endovascular Mechanical Thromboembolus Fragmentation in the Treatment of Critical Pulmonary Thromboembolism in Patients with Acute Hemorrhagic Stroke

A M Homenko et al. Sovrem Tekhnologii Med. 2020.

Abstract

The aim of the study was to evaluate the effectiveness of endovascular mechanical thromboembolus fragmentation in the treatment of critical pulmonary thromboembolism in patients with acute hemorrhagic stroke.

Materials and methods: The study included 47 patients with acute hemorrhagic stroke complicated by massive high-risk pulmonary thromboembolism with critical manifestations of the right ventricular failure. All patients were divided into two groups depending on the treatment method: the examined group (n=17) undergone endovascular mechanical thromboembolus fragmentation and the control group (n=30) received only basic intensive therapy.

Results: Thromboembolus fragmentation was performed on patients of the examined group in order to transfer embolism of the trunk and main branches to the smaller branches of the pulmonary artery. The technical success of the procedure (destruction of the central thromboembolus) was achieved in 100% of cases. 14 patients (82.4%) showed positive clinical dynamics: improvement of general condition, reduction of pulmonary artery pressure, decreased volume of pulmonary bed damage according to CT angiography. Three patients (17.6%) died in the early postoperative period. Twenty five patients from the control group died, hospital mortality rate was 83.3%. There were no deaths in the examined group after 6-9 months of follow-up, signs of pulmonary hypertension persisted in 11 patients (64.7%).

Conclusion: Endovascular mechanical thromboembolus fragmentation in the treatment of critical pulmonary thromboembolism in patients with acute hemorrhagic stroke results in fast and safe decrease in pulmonary artery pressure. Fragmentation of central thromboembolus and its displacement into the peripheral vascular bed with a modified pigtail catheter is a minimally invasive surgical procedure which may be used as an alternative to surgical embolectomy in cases of an extremely high risk of surgery and absolute contraindications to thrombolytic therapy.

Keywords: critical PTE; endovascular mechanical thromboembolus fragmentation; hemorrhagic stroke.

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Conflict of interest statement

Conflicts of interest. The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Rotary pigtail catheter for fragmentation of thromboemboli in pulmonary arteries
Figure 2
Figure 2. Dynamics of systolic pulmonary artery pressure (SPAP) before and after treatment; * p≤0.05
Figure 3
Figure 3. Patient N., 56 years old. MSCT angiography of the pulmonary arteries. Presence of thromboemboli in the distal parts of the pulmonary arteries with obstruction of their lumen
Figure 4
Figure 4. Insertion of the rotary pigtail catheter (а) and thromboembolus fragmentation in the pulmonary arteries under control (b)
See this image and copyright information in PMC

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