In vitro evaluation of different embolectomy catheters for the treatment of acute pulmonary embolism.

Introduction: Pulmonary embolism (PE) ist one of the most common cardiovasc ular diseases and frequently causes death. As a rule, PE is treated with th rombolytic therapy or surgical thrombectomy. Materials and Methods: In an i n vitro model of the right lung, we tested four different percutaneous tran sluminal thrombectomy devices: a pigtail-catheter with an angled 3-cm (40 d egrees) distal tip, the clot-buster, the hydrolyser catheter, and a modifie d hydrolyser. In 16 consecutive and repetitive experiments fresh thrombi we re inserted and we evaluated the effectiveness of the system with respect t o time, fragment size, reduction of the Miller score, and handling. Results : Mean intervention times of the catheter systems were 23 min (pigtail), 14 .4 min (modified hydrolyser), 13.8 min (clot-buster), and 10.8 min (hydroly ser). The maximum size of the produced fragments range from 0.5 to 3.5 mm b y the pigtail and from 0.5 to 1 mm by the other systems. The Miller score r eduction was from 14.4 to 2.8 (pigtail), 13.8 to 1.8 (clot-busters), 14.6 t o 1.2 (hydrolyser), and 16.4 to 1 (modified hydrolyser). Discussion: All fo ur catheter systems were effective in the treatment of pulmonary embolism. The pigtail catheter is the most simple system but more time consuming and less effective in the fragmentation of emboli and reduction of the Miller s core compared to the other three catheter systems. These systems were compa rable in our model but especially the handling of the hydrolyser was encour aging.