Yonago Acta medica 2010;53:017–024
Local Thrombolysis for Acute Massive Pulmonary Embolism using a Pulse-Infusion-Thrombolysis Catheter
Yujiro Ina*†, Katsuhiro Kondo*, Masashi Iwabuchi*, Masakiyo Nobuyoshi*, Toshio Kaminou† and Toshihide Ogawa†
*Clinic of Cardiology, Kokura Memorial Hospital, Kitakyushu 802-8555 and †Division of Radiology, Department of Pathophysiological Therapeutic Science, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
Acute massive pulmonary embolism (PE) is a common life-threatening condition requiring emergent and suitable treatment. The aim of this study is to assess the efficacy and safety of local thrombolysis with a pulse-infusion-thrombolysis (PIT) catheter in the management of acute massive PE. Thirty-nine patients with PE were treated with catheter directed intervention (CDI). CDI involves suction embolectomy and local thrombolysis with a PIT catheter. Procedural success was achieved in all patients (100%). After the CDI, a significant increase of mean systemic blood pressure was observed (93.8 ± 22.0 mmHg versus 100.8 ± 22.9 mmHg, P=0.02), and pulmonary perfusion on the basis of Miller score was improved (19.6 ± 7.6 versus 16.3 ± 7.1, P=0.04). Clinical success was achieved in 36 of 39 patients (92.3%). Two patients died of PE after CDI despite a successful recanalization, and 1 patient died of disseminated intravascular coagulation after the CDI. No major complication occurred in the remaining 36 patients and minor complications developed in 3 patients (7.7%). Local thrombolysis using a PIT catheter for massive PE is safe and effective treatment with minimal complication.
Key words: catheter; pulmonary embolism; thrombolysis; tissue plasminogen activator
