Fragmentation of massive pulmonary embolism by pigtail rotation catheter: possible complication

Fragmentation by pigtail rotation catheter may be a therapeutic option in a cute massive pulmonary embolism, especially in patients with high risk of r ight ventricular failure. We report a patient with an occlusion of the righ t intermediate pulmonary artery by a large embolus, slightly protruding int o the perfused right upper lobe artery. After initial catheter fragmentatio n, part of the embolus dislocated and produced an additional occlusion of t he upper lobe artery. Hemodynamic parameters deteriorated. Continuation of catheter fragmentation finally provided for a hemodynamic stabilization and partial recanalization. Inadvertent occlusion of a major pulmonary arteria l branch by dislocated embolus material may be considered as a complication of catheter fragmentation, which can be successfully managed by continuati on of the fragmentation therapy.