ReviewCatheter-Tip Embolectomy in the Management of Acute Massive Pulmonary Embolism
Section snippets
Methods
The results of catheter-tip devices in patients with massive PE were reviewed using established methods for systematic review.14, 15, 16 The electronic search was performed using PubMed, which includes Medline, OLDMEDLINE, Ovid, and the Cochrane Library database. The search terms were “embolectomy,” “catheter embolectomy,” “mechanical embolectomy,” “fragmentation,” “catheter fragmentation,” “catheter-tip fragmentation,” “catheter suction and suction embolectomy,” “Greenfield catheter,” “pigtail
Results
Individual case series showing hemodynamic parameters and clinical success are listed in Table 1 (catheter embolectomy alone) and Table 2 (catheter embolectomy in combination with thrombolytic agents). Pooled data are listed in Table 3.
Pooled data showed that clinical success with the Greenfield catheter, when used alone, occurred in 72 of 89 patients (81%; Table 3). The success rate with the steel-cup catheter appeared to be somewhat higher, 23 of 27 patients (85%),5, 6, 7 than with the
Discussion
No randomized clinical trials have been undertaken to determine the efficacy of catheter embolectomy devices. Only case series and case reports were available for analysis. We pooled the data when similar techniques of embolectomy or fragmentation were used. Although originally it was thought that catheter embolectomy or fragmentation could substitute for thrombolytic therapy, it now appears to be an adjunct to thrombolytic therapy. All of the devices analyzed in this study appear to be useful
Acknowledgment
Julia Sanchez, MD, Fadi Kayali, MD, and Michael Alkhalil, MD, assisted in this investigation.
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