FRAGMENTATION OF MASSIVE PULMONARY-EMBOLISM USING A PIGTAIL ROTATION CATHETER

Study objectives: The purpose of this study was the evaluation of the efficacy and safety of mechanical fragmentation of acute massive pulmo nary emboli with a rotatable pigtail catheter. Material and methods: T en patients (4 female, 6 male, age 53.8 +/- 9.5 years) with acute mass ive pulmonary embolism with hemodynamic impairment were included in th e study, The fragmentation catheter device (William Cook Europe A/S; B jaerverskov, Denmark) consisted of a 5F catheter embedded in a flexibl e 5.5F sheath, Pulmonary emboli were fragmented by mechanical action o f the recoiled rotating pigtail, while the guide wire was exiting an o val side hole proximal to the pigtail tip. In eight cases, an addition al thrombolysis was performed. Results: Fragmentation was successful i n 7 of 10 patients, Average percentage of recanalization by fragmentat ion was 29.2 +/- 14.0%, and 36.0 +/- 10.0% exclusively of the seven su ccessful cases. Average shock index decreased significantly prefragmen tation to postfragmentation from 1.52 to 1.22 (p = 0.03) and to 0.81 4 8 h later (p < 0.001). Decrease of the average mean arterial pulmonary pressure prefragmentation to postfragmentation was insignificant (fro m 33 to 31 mm Hg, p = 0.14); further decrease within the 48 h follow-u p was highly significant (from 31 to 21 mm Kg, p < 0.001) due to a syn ergy of fragmentation and thrombolysis (average dose 63 +/- 25 mg plas minogen activator). There were no procedure-related complications. Ove rall mortality rate was 20%. Conclusion: Fragmentation of massive pulm onary emboli with the pigtail rotation catheter achieved rapid partial recanalization in most cases, with ease of instrumentation, and witho ut complications. Hemodynamic stabilization was completed in synergy w ith thrombolysis.