Published online Nov 28, 2013. doi: 10.4329/wjr.v5.i11.430
Revised: October 18, 2013
Accepted: November 2, 2013
Published online: November 28, 2013
AIM: To report our preliminary experience with a new generation aspiration catheter in the treatment of symptomatic pulmonary embolism (PE).
METHODS: A retrospective database search for pulmonary artery embolectomy since introduction of the Pronto .035” and XL extraction catheter (Vascular Solutions, Minneapolis, MN) at our institution in 10/2009 was performed. Ten consecutive patients were identified in which the Pronto .035” or XL catheter was used between 01/2010 and 03/2013. All patients were referred for catheter based embolectomy due to contraindications to systemic lysis, or for being in such a critical clinical condition that immediate percutaneous treatment deemed warranted. The computed tomography (CT) right to left heart ratio as predictor for the severity of the PE was retrospectively evaluated on standard axial views. The difference between pre- and post-procedure pulmonary pressure measures was taken to assess the procedural effect.
RESULTS: Extensive PE was confirmed angiographically in all patients. Measured right- to left ventricle (RV/LV) ratios were elevated beyond one in seven of the eight available CTs. Acute procedural success defined as clinical removal of visible thrombus and improvement in mean pulmonary artery pressure was seen in all recorded patients (n = 8), the mean pulmonary pressures declined from a median (range) of 35.5 (19-46) to 23 (10-37, P = 0.008) mmHg. Neither death nor other complications occurred intra- or immediately periprocedural, yet short term mortality within 30 d was found in 6 out of 9 patients, one patient was lost in follow up. The cause of death within 30 d in the 6 patients was identified as: Circulatory failure in direct connection with the PE (n = 2), stroke, sepsis, or succumbing to malignancy in a hospice setting (n = 2).
CONCLUSION: Success in thrombus removal with improved pulmonary hypertension and systemic hypotension suggests this aspiration technique to be effective. Aspiration catheters should be part of further trials.
Core tip: We present a new aspiration catheter for use in pulmonary embolism (PE) (Pronto .035” and XL extraction catheter, Vascular Solutions, Minneapolis, MN) in a case series of ten patients. The aspiration catheter allowed fast thrombus removal and lowered mean pulmonary artery pressure. No peri-procedural complications occurred, but high 30-d mortality remained. Catheter based aspiration embolectomy should be considered in acute symptomatic PE, since it is fast and does not require additional special equipment, thus signifying a widely applicable technique. Aspiration embolectomy should be included in further trials treating symptomatic PE.