Acute Massive and Submassive Pulmonary Embolism

Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis

Massimo Pieraccini, Susanna Guerrini, Edoardo Laiolo, Alessio Puliti, Giandomenico Roviello, Leonardo Misuraca, Genni Spargi, Ugo Limbruno, Mauro Breggia, Morando Grechi

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. Materials and Methods: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score. Results: Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO2), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence. Conclusion: The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.

Original languageEnglish
Pages (from-to)1840-1848
Number of pages9
JournalCardioVascular and Interventional Radiology
Volume41
Issue number12
DOIs
Publication statusPublished - Dec 1 2018

Fingerprint

Thrombectomy
Pulmonary Embolism
Stroke
Craniocerebral Trauma
Pulmonary Hypertension
Pulmonary Artery
Intensive Care Units
Hospitalization
Central Nervous System
Heart Rate
Prospective Studies
Hemorrhage
Oxygen
Blood Pressure
Recurrence
Lung
Wounds and Injuries

Keywords

  • Catheter-directed treatment (CDT)
  • Computed tomography angiography (CTA)
  • Massive pulmonary embolism
  • Pulmonary embolism (PE)
  • Submassive pulmonary embolism
  • Thrombolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Acute Massive and Submassive Pulmonary Embolism : Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis. / Pieraccini, Massimo; Guerrini, Susanna; Laiolo, Edoardo; Puliti, Alessio; Roviello, Giandomenico; Misuraca, Leonardo; Spargi, Genni; Limbruno, Ugo; Breggia, Mauro; Grechi, Morando.

In: CardioVascular and Interventional Radiology, Vol. 41, No. 12, 01.12.2018, p. 1840-1848.

Research output: Contribution to journalArticle

Pieraccini, Massimo ; Guerrini, Susanna ; Laiolo, Edoardo ; Puliti, Alessio ; Roviello, Giandomenico ; Misuraca, Leonardo ; Spargi, Genni ; Limbruno, Ugo ; Breggia, Mauro ; Grechi, Morando. / Acute Massive and Submassive Pulmonary Embolism : Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis. In: CardioVascular and Interventional Radiology. 2018 ; Vol. 41, No. 12. pp. 1840-1848.
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abstract = "Purpose: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. Materials and Methods: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44{\%}) were women and 10 (55.55{\%}) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score. Results: Technical and procedural success was achieved in 18 patients (100{\%}), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78{\%}), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO2), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence. Conclusion: The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.",
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AU - Guerrini, Susanna

AU - Laiolo, Edoardo

AU - Puliti, Alessio

AU - Roviello, Giandomenico

AU - Misuraca, Leonardo

AU - Spargi, Genni

AU - Limbruno, Ugo

AU - Breggia, Mauro

AU - Grechi, Morando

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N2 - Purpose: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis. Materials and Methods: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51–87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score. Results: Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO2), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2–12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence. Conclusion: The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.

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