Catheter-Tip Embolectomy in the Management of Acute Massive Pulmonary Embolism

doi:10.1016/j.amjcard.2006.08.052

The American Journal of Cardiology

Volume 99, Issue 3, 1 February 2007, Pages 415-420

https://doi.org/10.1016/j.amjcard.2006.08.052 Get rights and content

Three catheter interventional techniques are currently available for removing or fragmenting pulmonary emboli: aspiration thrombectomy, fragmentation, and rheolytic thrombectomy. The investigators systematically reviewed all available published research related to the use of catheter-tip devices in patients with pulmonary emboli. Pooled data showed that clinical success with the Greenfield catheter occurred in 72 of 89 patients (81%) when used alone and in 19 of 19 patients (100%) when used in combination with thrombolytic agents. Fragmentation with standard catheters used alone (without thrombolytic agents) was reported in only 3 patients. Clinical success with standard angiographic catheters occurred in 15 of 21 patients (71%) when used in combination with systemic thrombolytic agents and in 115 of 121 patients (95%) when used with local infusions of thrombolytic agents. Data for the Amplatz catheter, the rheolytic Angiojet catheter, and the Hydrolyser catheter when used alone were sparse or absent. Clinical success when used in combination with thrombolytic agents occurred in 6 of 6 patients (100%) with the Amplatz catheter, in 20 of 23 patients (87%) with the Angiojet catheter, and in 19 of 20 patients (95%) with the Hydrolyser catheter. Minor bleeding at the insertion site among all patients, with and without thrombolytic agents, occurred in 29 of 348 patients (8%), and major bleeding at the insertion site occurred in 8 of 348 patients (2%). One patient experienced perforation of the right ventricle with the Greenfield catheter. None reported perforation of a pulmonary artery. In conclusion, all the devices analyzed in this study appear to be useful in the management of acute massive pulmonary emboli.

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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ReviewCatheter-Tip Embolectomy in the Management of Acute Massive Pulmonary Embolism

Section snippets

Methods

Results

Discussion

Acknowledgment

J Surg Res

Chest

Chest

J Thorac Cardiovasc Surg

Tech Vasc Interv Radiol

J Vasc Interv Radiol

Chest

Chest

Lancet

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

Clin Radiol

Chest

Am J Cardiol

Lancet

J Am Coll Cardiol

A new treatment for severe pulmonary embolism: percutaneous rheolytic thrombectomy

Circulation

Transvenous pulmonary embolectomy by catheter device

Ann Surg

Long-term experience with transvenous catheter pulmonary embolectomy

J Vasc Surg

Transvenous catheter embolectomy

Semin Vasc Med

Catheter technique for pulmonary embolectomy or thrombofragmentation

Semin Vasc Surg

Management of pulmonary thrombo-embolism using catheter manipulation: a report of four cases and review of the literature

Postgrad Med J

Novel percutaneous catheter thrombectomy in acute massive pulmonary embolism: rotational bidirectional thrombectomy (ROBOT)

Catheter Cardiovasc Interv

The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration

Ann Intern Med

Review
Catheter-Tip Embolectomy in the Management of Acute Massive Pulmonary Embolism