Massive pulmonary embolism: Percutaneous emergency treatment by pigtail rotation catheter

OBJECTIVES This study was designed to assess the feasibility, efficacy and safety of mechanical fragmentation of pulmonary emboli using a new rotation al pigtail catheter system. BACKGROUND Acute massive pulmonary embolism associated with right ventricul ar dysfunction is frequently lethal, despite high-dose thrombolytic therapy . Adjunctive catheter fragmentation may prevent a fatal outcome. METHODS In 20 patients (age 58.9 +/- 10.5 years) with severe hemodynamic im pairment, massive pulmonary emboli were fragmented by mechanical action of the rotating pigtail. Fifteen patients received thrombolysis after embolus fragmentation or no thrombolysis at all (noninterference group). RESULTS Prefragmentation pulmonary arterial occlusion was 68.6 +/- 11.3% fo r both lungs. Pulmonary placement and navigation of the fragmentation cathe ter was easy and rapid. Fragmentation time was 17 +/- 8 min. The noninterfe rence group showed a decrease pre- to postfragmentation of shock index from 1.28 +/- 0.53 to 0.95 +/- 0.38 (p = 0.011), mean pulmonary artery pressure from 31 +/- 5.7 to 28 +/- 7.5 mm Hg (p = 0.02) and a recanalization by fra gmentation of 32.9 +/- 11.8% (mean angiographic score per treated lung from 7.4 to 5.0). Overall mortality was 20%. CONCLUSIONS Fragmentation by pigtail rotation catheter provided for a rapid and safe improvement of the hemodynamic situation and an average recanaliz ation of about one-third of the pulmonary embolic occlusion. The method app ears useful especially in high-risk patients threatened by right ventricula r failure, to accelerate thrombolysis, and as a minimal-invasive alternativ e to surgical embolectomy. (C) 2000 by the American College of Cardiology.