BJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Radiology (2008) 81, 848-854
© 2008 British Institute of Radiology
doi: 10.1259/bjr/93840362
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by NAKAZAWA, K
Right arrow Articles by TANAKA, K
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by NAKAZAWA, K
Right arrow Articles by TANAKA, K
British Journal of Radiology 81 (2008),848-854 ©2008 The British Institute of Radiology

Full paper

Catheter fragmentation of acute massive pulmonary thromboembolism: distal embolisation and pulmonary arterial pressure elevation

K NAKAZAWA, MD 1 H TAJIMA, MD, PhD 1 S MURATA, MD, PhD 1 S-I KUMITA, MD, PhD 1 T YAMAMOTO, MD, PhD 2 and K TANAKA, MD, PhD 2

1 Department of Radiology/Center for Advanced Medical Technology, 2 Department of Internal Medicine/Coronary Care Unit, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan

Correspondence: Ken Nakazawa, Department of Radiology/Center for Advanced Medical Technology, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan. E-mail: ctnb{at}nms.ac.jp

The aim of this study was to evaluate the relationship between pulmonary arterial pressure and distal embolisation during catheter fragmentation for the treatment of acute massive pulmonary thromboembolism with haemodynamic impairment. 25 patients with haemodynamic impairment (8 men and 17 women; aged 27–82 years) were treated by mechanical thrombus fragmentation with a modified rotating pigtail catheter. After thrombus fragmentation, all patients received local fibrinolytic therapy, followed by manual clot aspiration using a percutaneous transluminal coronary angioplasty (PTCA) guide catheter. Pulmonary arterial pressure was continuously recorded during the procedure. The Friedman test and Wilcoxon test were applied for statistical analysis. Distal embolisation was confirmed by digital subtraction angiography in 7 of the 25 patients. A significant rise in mean pulmonary arterial pressure occurred after thrombus fragmentation (before: 34.1 mmHg; after: 37.9 mmHg; p<0.05), and this group showed a significant decrease in mean pulmonary arterial pressure after thrombus aspiration (25.7 mmHg; p<0.05). No distal embolisation was seen in 18 of the 25 patients, and a significant decrease in mean pulmonary arterial pressure was confirmed after thrombus fragmentation (before: 34.2 mmHg; after: 28.1 mmHg: p<0.01), and after thrombus aspiration (23.3 mmHg; p<0.01). In conclusion, distal embolisation and a rise in pulmonary arterial pressure can occur during mechanical fragmentation using a rotating pigtail catheter for the treatment of life-threatening acute massive pulmonary thromboembolism; thrombolysis and thrombus aspiration can provide partial recanalization and haemodynamic stabilization. Continuous monitoring of pulmonary arterial pressure may contribute to the safety of these interventional procedures.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
BJR DMFR IMAGING  ALL BIR JOURNALS 
Copyright © 2008 by the British Institute of Radiology.