Percutaneous catheter and guidewire fragmentation with local administration of recombinant tissue plasminogen activator as a treatment for massive pulmonary embolism

The purpose of this article is to report four patients with massive pulmona ry embolism treated with percutaneous catheter and guidewire fragmentation and local administration of recombinant tissue plasminogen activator (r-TPA ), Four patients with massive pulmonary embolism initially underwent pulmon ary angiography. Thrombus fragmentation was performed with both standard an giographic guidewires and catheters followed by local infusion : of 41-200 mg of r-TPA. Pulmonary angiography was : repeated after treatment. All pati ents survived with improvement in their clinical status and eventual discha rge from hospital. Angiography in all patients post treatment demonstrated improvement in pulmonary perfusion (mean Miller score before treatment 22.5 ; mean Miller score after treatment 5.75). Nd patient had a significant com plication. Mechanical fragmentation of the thrombus followed by local infus ion of r-TPA was an effective treatment for massive pulmonary embolism in t hese four patients with no significant complications.