Document Detail


Clinical outcome of catheter fragmentation and aspiration therapy in patients with acute pulmonary embolism
MedLine Citation:
PMID:  10466088     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The clinical usefulness of catheter fragmentation and aspiration therapy was studied in 8 patients with acute pulmonary embolism who received thrombolytic therapy using urokinase or tissue-type plasminogen activator (t-PA) (thrombolysis group) and 8 patients who underwent catheter fragmentation and aspiration therapy using a percutaneous transluminal coronary angioplasty (PTCA) guide catheter (catheter group). The patients were selected from 20 patients with a definite diagnosis of acute pulmonary embolism based on pulmonary arteriography and nuclear imaging. Urokinase (48 x 10(4) to 96 x 10(4) unit/day) or t-PA (12 x 10(6) unit/day) was administered intravenously for mean 4 days in the thrombolysis group. Pulmonary artery pressure was first measured using a Swan-Ganz catheter via the jugular vein or the femoral vein in the catheter group. Then, a PTCA guide catheter was advanced into the pulmonary artery, and the thrombus was disrupted repeatedly using a Radifocus wire, followed by manual aspiration. Subsequent treatment consisted of intravenous infusion of heparin (10,000 to 15,000 unit/day) and urokinase (24 x 10(4) to 48 x 10(4) unit/day) for mean 6 days. Partial revascularization was achieved in all patients in both groups. Five patients in the thrombolysis group died within 1 month due to respiratory failure, re-embolization, and/or hemorrhagic complications. One patient in the catheter group died of hemorrhagic shock. Pulmonary artery systolic pressure in the catheter group was significantly reduced from 47.4 to 26.5 mmHg (p < 0.01). Catheter treatment of acute pulmonary embolism associated with acute circulatory failure such as shock can lead to rapid hemodynamic improvement. In contrast, thrombolysis is an effective treatment, but bleeding problems are common and caution is required. Catheter fragmentation and aspiration therapy is effective for acute pulmonary embolism, is minimally invasive, and should be considered the treatment of first choice.
Authors:
S Hiramatsu; A Ogihara; Y Kitano; M Mashiko; S Iseki; J Muramatsu; T Izumi
Publication Detail:
Type:  Case Reports; English Abstract; Journal Article    
Journal Detail:
Title:  Journal of cardiology     Volume:  34     ISSN:  0914-5087     ISO Abbreviation:  J Cardiol     Publication Date:  1999 Aug 
Date Detail:
Created Date:  1999-09-22     Completed Date:  1999-09-22     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8804703     Medline TA:  J Cardiol     Country:  JAPAN    
Other Details:
Languages:  jpn     Pagination:  71-8     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Numazu City Hospital, Shizuoka.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / instrumentation*
Female
Humans
Male
Middle Aged
Pulmonary Embolism / therapy*
Suction / methods
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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