Document Detail


Usefulness of Aspiration of Pulmonary Emboli and Prolonged Local Thrombolysis to Treat Pulmonary Embolism.
MedLine Citation:
PMID:  22980966     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Catheter-based treatment of pulmonary embolism (PE) has been demonstrated to be successful in case reports and small series. The investigators report the results of a novel, pharmacomechanical approach with prolonged infusion of urokinase in the occluded pulmonary arteries (PAs). Manual aspiration of thrombus using guide catheters was followed by introduction of thrombolysis catheters and a local bolus of urokinase. The lysis catheters were left in place, and repeat PA cine angiography and right-sided cardiac catheterization was performed 3 days later. A total of 63 patients (mean age 60 ± 15 years) were treated over 8 years: 17 patients (27%) had massive and 46 patients (73%) submassive PE. The mean PA pressure was 35 ± 10 mm Hg, and 54% had central bilateral PE. Five patients died, 1 before, 1 during, and 3 after the intervention. Nine patients (14%) had major bleeds (hemoglobin decrease >30 g/L), but in none of these patients was bleeding the reason for fatal outcome. After 3.3 ± 1.0 days, 49 of 58 living patients (84%) were restudied. In 29 (59%), there was a reduction of thrombotic burden by >90%, and in 14 (29%), the reduction was 50% to 90%. Mean PA pressure was reduced from 33 ± 8 to 21 ± 7 mm Hg (p <0.001), and this was not dependent on a reduction of thrombus. In conclusion, manual aspiration and application of prolonged thrombolysis is feasible and safe. Improvement of PA pressures is impressive and there is no correlation between morphologic disappearance of thrombus and normalization of PA pressures.
Authors:
Florim Cuculi; Richard Kobza; Michael Bergner; Paul Erne
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-13
Journal Detail:
Title:  The American journal of cardiology     Volume:  -     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland.
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