Interventional Treatment Of Acute Massive Pulmonary Embolism

Objective: to evaluate the effectiveness of pulmonary embolectomy by catheter for the treatment of acute massive pulmonary embolism .Methods: Ten patients were diagnosed massive pulmonary embolism by pulmonary angiography and spiral computed tomography pulmonary angiography (CTPA), treated by thrombus fragmentation and suction by catheters, and local thrombolysis. Quantitative angiographic assessment of pre and posttreatment angiograms adopted the angiographic severity index defined by multicenter clinical trial on the efficacy of thrombolysis and anticoagulant therapy in pulmonary thromboembolism(PTE) . Unilateral angiograms were graded from 0 (no clot) to 10 (entire lung affected), the maximum score was 20. Recanalization of the occlusion (expressed as a percentage) was calculated as follows: [(score pre- score post)/score pre] ×100. According to the mean percentage of recanalization, peripheral intravenous thrombolysis was adopted .Then anticoagulant therapy was followed. The symptoms ,oxygen saturation and the change of the mean PTCA score were observed after the procedure.Results: Treatment resulted in immediate improvement of PTE symptoms, oxygen saturation increased significantly pretreatment to posttreatment from86±9.3% to 96±4.2%(p < 0.01) and to 98±1.7% 1 weak later (p < 0.05), The difference was significant. There was a significant decrease of the mean PTCA score 5~10days after therapy (P< 0.01). The difference was also significant. The mean percentage of recanalization was40.1 ±30.0%. In 2of the 10patients(No.5 ,1 ),a significant decrease of the mean CTPA score were observed 2 weak after therapy. In 1 of the 10patients(No.8), the mean PTCA score were 0 during the period of follow up for 3month. One patient (No.5)with subacute massive pulmonary embolism also had a significant decrease of the mean CTPA score after therapy. But 2 of the 10 patients (No.9,10 ) diagnosed chronic pulmonary thromboembolism hypertension didn't presented with improvement of CTPA score. One patient had hematoma at puncture position.Conclusion: pulmonary embolectomy by catheter is a safe and effective procedure to treat acute and subacute massive pulmonary embolism and improve recent and mid-term prognosis.