Margheri Massimo, Vittori Guido, Vecchio Sabine, Chechi Tania, Falchetti Elena, Spaziani Gaia, Giuliani Gabriele, Rovelli Serena, Consoli Lorenzo, Biondi Zoccai Giuseppe G L
Dipartimento del Cuore e dei Vasi, Cardiologia e Cardiologia Invasiva 2, A.O.U. Careggi, Florence, Italy.
Am J Cardiol. 2008 Jan 15;101(2):252-8. doi: 10.1016/j.amjcard.2007.07.087.
Anticoagulant and thrombolytic therapies are a mainstay in the management of acute pulmonary embolism (PE), especially when hemodynamic compromise is present. However, systemic drugs cannot achieve timely and effective treatment of acute PE in all patients. In such a setting, mechanical removal of thrombus from the pulmonary circulation holds the promise of significant clinical benefits, although it remains untested. We report early and long-term outcome of patients with massive or submassive acute PE treated with rheolytic thrombectomy by means of the 6Fr Xpeedior AngioJet device at our institution. Three main groups were defined pre hoc: subjects with severe (i.e., shock), moderate, or mild hemodynamic compromise. Technical and procedural successes, obstruction, perfusion and Miller indexes, and clinical events were appraised. In total 25 patients were treated with thrombectomy (8 in severe, 12 in moderate, and 5 in mild hemodynamic compromise). Technical and procedural successes were obtained in all patients, as confirmed by the significant improvement in obstruction, perfusion and Miller indexes overall, and in each subgroup (all p values <0.001). Improvement in obstruction, perfusion, and Miller indexes at the end of the procedure could also be confirmed in patients (n = 8) treated with local fibrinolysis and in the absence of concomitant thrombolysis (n = 17, p <0.05). Four patients died in hospital, all other patients but 1 were safely discharged after an appropriate hospital stay, and all were alive at long-term follow-up (median 61 months). In conclusion, this study supports at early and long-term follow-up the effectiveness and safety of rheolytic thrombectomy for PE.
抗凝和溶栓治疗是急性肺栓塞（PE）治疗的主要手段，尤其是在存在血流动力学障碍时。然而，全身性药物并不能在所有患者中实现对急性PE的及时有效治疗。在这种情况下，从肺循环中机械清除血栓有望带来显著的临床益处，尽管这仍未经检验。我们报告了在我们机构使用6Fr Xpeedior AngioJet装置进行流变血栓切除术治疗大面积或次大面积急性PE患者的早期和长期结果。预先定义了三个主要组：严重（即休克）、中度或轻度血流动力学障碍的患者。评估了技术和操作成功率、阻塞、灌注和米勒指数以及临床事件。共有25例患者接受了血栓切除术（严重血流动力学障碍8例，中度12例，轻度5例）。所有患者均取得了技术和操作成功，总体以及各亚组的阻塞、灌注和米勒指数均有显著改善证实了这一点（所有p值<0.001）。在接受局部纤溶治疗且未同时进行溶栓治疗的患者（n = 17，p <0.05）中，也可证实术后阻塞、灌注和米勒指数有所改善（n = 8）。4例患者在医院死亡，所有其他患者（除1例）在适当住院后安全出院，且在长期随访（中位61个月）时均存活。总之，本研究在早期和长期随访中支持了流变血栓切除术治疗PE的有效性和安全性。
