Mechanical thrombectomy of major and massive pulmonary embolism with use of the Amplatz thrombectomy device

RATIONALE AND OBJECTIVES. TO evaluate the feasibility of mechanical thrombe ctomy with the Amplatz thrombectomy device (ATD) in restoring patency of ac utely thrombosed pulmonary arteries resulting from pulmonary embolism for t he improvement of patient outcome. METHODS, Mechanical thrombectomy with the ATD (8F) was performed in nine co nsecutive patients with angiographically documented thrombus in the left or right pulmonary artery resulting from deep vein thrombosis (n = 4) or unkn own cause (n = 5), RESULTS. The Miller index decreased from 18 to 11, In all patients, the maj ority of the thrombus in the pulmonary artery was cleared after a mean acti vation time of the ATD of 367 seconds, Thrombectomy was performed with the ATD alone (n = 4) or with additional long-term fibrinolysis therapy (n = 5) with infusion of recombinant tissue-type plasminogen activator. Pulmonary arterial pressure decreased from a mean of 57 mm Hg before mechanical throm bectomy to 55 mm Hg directly after the procedure and to 39 mm Hg after term ination of the recombinant tissue-type plasminogen activator infusion. CONCLUSIONS. Mechanical thrombectomy with the ATD in patients with minor an d major pulmonary embolism is technically feasible and safe. It is a potent ial alternative to drug-mediated thrombolysis and surgery. However, the inc remental benefit of the ATD over conventional treatments could be shown onl y in a randomized controlled study.