Heart, Lung and Circulation (2015) 24, e130–e132 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2015.03.024

CLINICAL SPOTLIGHT

Effective Treatment of Intermediate-Risk Pulmonary Embolism by Manual Thrombus Aspiration. A Report of Two Cases Rodrigo Sebik a, Bernardo Cortese a*, Dario Buccheri b, Pedro Silva-Orrego a, Andrea Rubboli c a

Interventional Cardiology, A.O. Fatebenefratelli, Milano, Italy Interventional Cardiology, A.O.U.P. Paolo Giaccone, Palermo, Italy c Interventional Cardiology, O. Maggiore, Bologna, Italy b

Received 3 February 2015; received in revised form 26 March 2015; accepted 27 March 2015; online published-ahead-of-print 29 April 2015

Manual thrombectomy, part of the armamentarium of interventional cardiologists, might also be considered as an effective and safe alternative to manage intermediate/high risk acute PE patients with contraindications to thrombolysis or with acute haemodynamic decompensation. We here describe two cases with intermediate risk pulmonary embolism and severe hypoxaemia where manual thrombectomy with a 10F dedicated catheter was effective and improved clinical and haemodynamic parameters. Currently, there’s no clear and effective treatment for these patients, thus we believe that this therapy, as current ESC guidelines suggest, should become a possible alternative to systemic thrombolysis and anticoagulant regimen. Keywords

Pulmonary embolism  Manual thrombectomy  Intermediate risk

Parenteral anticoagulation with heparin, or oral administration of the non-vitamin-K-antagonist rivaroxaban, is currently recommended for the initial treatment of intermediate-risk acute pulmonary embolism (PE) [1]. Because of the uncertain net clinical benefit, thrombolysis or percutaneous catheterdirected treatment may only be considered in the presence of signs of haemodynamic deterioration or when the anticipated risk of bleeding is high, respectively [1]. Nonetheless, the benefit of thrombolytic treatment in patients with acute PE at intermediate risk has no impact on mortality, and comes at the price of a significantly increased incidence of major bleeding, including intracranial [2]. Whereas percutaneous catheter-directed treatment has been generally shown effective in patients with acute PE, the risk of procedural complications appears not trivial [3]. Furthermore, neither large nor solid data are available regarding the efficacy and safety of

percutaneous catheter-directed treatment of this disease. We report two cases of intermediate-risk acute PE patients effectively treated with manual thrombus aspiration. Case 1: A 54 year-old woman with a clinical history of glioblastoma multiforme, with no risk factors for venous thromboembolism was admitted because of suspected acute PE. Upon admission, she was in sinus rhythm (112 beats-perminute, bpm), blood pressure was 110/70 mmHg, and arterial O2 saturation 76%. The PESI index was 114 and troponine value 150ng/ml (r.v.

Effective Treatment of Intermediate-Risk Pulmonary Embolism by Manual Thrombus Aspiration. A Report of Two Cases.

Manual thrombectomy, part of the armamentarium of interventional cardiologists, might also be considered as an effective and safe alternative to manag...
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