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 rotational pigtail catheter system. BACKGROUND Acute massive pulmonary embolism associated with right ventricular 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 impairment, 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% for both lungs. Pulmonary placement and navigation of the fragmentation catheter was easy and rapid. Fragmentation time was 17 ± 8 min. The noninterference 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 fragmentation 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 recanalization of about one-third of the pulmonary embolic occlusion. The method appears useful especially in high-risk patients threatened by right ventricular failure, to accelerate thrombolysis, and as a minimal-invasive alternative to surgical embolectomy.