MECHANICAL FRAGMENTATION AND PHARMACOLOGICAL THROMBOLYSIS IN MASSIVE PULMONARY-EMBOLISM

PURPOSE: To evaluate the usefulness of mechanical fragmentation associ ated with intrapulmonary thrombolysis in acute massive pulmonary embol ism (PE). PATIENTS AND METHODS: Sixteen cases of massive PE treated wi th mechanical fragmentation associated with pharmacologic thrombolysis were retrospectively studied. Severity of PE was assessed with the an giographic index according to the Urokinase Pulmonary Embolism Trial ( maximum value of 18; score according to whether obstruction was centra l or peripheral, complete or partial). Mechanical fragmentation of the emboli was performed with angiographic catheters and angioplasty ball oons, Urokinase was infused directly into the thrombus during the cour se of 8-24 hours. The effect of therapy was measured with direct pulmo nary artery pressure (PAP) and blood O-2 values. RESULTS: Pre- and pos tinfusion ansographic index mean values (+/- standard deviation) were 13.7 +/- 1.4 and 6.1 +/- 2.2 (P <.0001). Mean pre- and postinfusion PA Ps were 48.2 +/- 13.4 and 18.5 +/- 7.2 mm Hg (P <.0001). PaO2 increase d from 60.1 +/- 12.1 to 88.7 +/- 23.4 mm Hg (P =.01). Fourteen patient s (87.5%) completely recovered. One patient died during treatment desp ite improvement in PAP and PaO2 parameters. There were no major hemorr hagic complications. CONCLUSIONS: The data support the efficacy of mec hanical fragmentation associated with pharmacologic thrombolysis in th e treatment of acute massive PE, resulting in improved hemodynamics an d blood oxygenation and in decreased PAP, with low morbidity.