Acute Massive and Submassive Pulmonary Embolism: Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis

• Published in: Cardiovascular and interventional radiology Vol. 41; no. 12; pp. 1840 - 1848
• Main Authors: Pieraccini, Massimo, Guerrini, Susanna, Laiolo, Edoardo, Puliti, Alessio, Roviello, Giandomenico, Misuraca, Leonardo, Spargi, Genni, Limbruno, Ugo, Breggia, Mauro, Grechi, Morando
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2018; Springer Nature B.V
• Subjects: Acute Disease; Aged; Aged, 80 and over; Arterial Interventions; Bleeding; Blood pressure; Cardiology; Central nervous system; Clinical Investigation; Embolism; Embolisms; Feasibility Studies; Female; Fibrinolytic Agents - therapeutic use; Heart rate; Humans; Hypertension; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasms; Nuclear Medicine; Oxygen content; Patients; Prospective Studies; Pulmonary arteries; Pulmonary artery; Pulmonary Embolism - surgery; Pulmonary embolisms; Radiology; Reproducibility of Results; Severity of Illness Index; Success; Suction; Surgery; Systolic pressure; Thrombectomy - methods; Thrombolysis; Thrombolytic Therapy - methods; Trauma; Treatment Outcome; Ultrasound; Ventricle; Catheter-directed treatment (CDT); Massive pulmonary embolism; Computed tomography angiography (CTA); Submassive pulmonary embolism; Thrombolysis; Pulmonary embolism (PE)
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-018-2011-3

Purpose The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. Materials and Methods Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n  = 1, ischaemic stroke in the preceding 6 months n  = 7, central nervous system damage or neoplasms n  = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n  = 5, gastrointestinal bleeding within the last month n  = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score. Results Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO 2 ), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence. Conclusion The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.