Salerno Anna, Latib Azeem, Ballarotto Carlo, Cappio Stefano, Camici Paolo G, Colombo Antonio
Dipartimento Cardio-Toraco-Vascolare, Ospedale San Raffaele, Milano.
G Ital Cardiol (Rome). 2013 Apr;14(4):289-92. doi: 10.1714/1257.13887.
A 76-year-old woman presented with a one-week history of dyspnea on minimal exertion and at rest. In the emergency room she underwent echocardiography and thoracic computed tomography scan with diagnosis of bilateral pulmonary embolism. Due to right ventricular dilatation and increasing values of NT-probrain natriuretic peptide, both markers of high risk that classify pulmonary embolism as "submassive" according to current international guidelines, we opted for thrombolysis. The patient underwent intra-arterial bilateral pulmonary thrombolysis facilitated by ultrasound, the first case in Italy. The patient recovered from pulmonary embolism after 10h of therapy, with improved gas exchange and symptoms. Subsequently, she developed arterial bleeding at the puncture site, due to accidental puncture of a branch of the femoral artery. The patient was treated with percutaneous embolization and transfusions. In patients with pulmonary embolism, even if not massive, thrombolysis should be considered, especially in the presence of high-risk markers. Direct intra-arterial pulmonary thrombolysis, facilitated by ultrasound, is an effective procedure that provides an alternative to conventional thrombolysis with the advantage of a lower thrombolytic dose.
一名76岁女性因轻微活动及休息时均出现呼吸困难一周前来就诊。在急诊室，她接受了超声心动图和胸部计算机断层扫描，诊断为双侧肺栓塞。由于右心室扩张以及N末端脑钠肽前体值升高，根据当前国际指南，这两个高危指标将肺栓塞归类为“次大面积”，我们选择了溶栓治疗。该患者接受了超声辅助下的双侧肺动脉内溶栓，这在意大利尚属首例。治疗10小时后，患者从肺栓塞中康复，气体交换和症状均有所改善。随后，由于意外穿刺股动脉分支，她在穿刺部位出现动脉出血。患者接受了经皮栓塞和输血治疗。对于肺栓塞患者，即使不是大面积的，也应考虑溶栓治疗，尤其是在存在高危指标的情况下。超声辅助下的直接动脉内肺溶栓是一种有效的方法，它为传统溶栓提供了一种替代方案，具有溶栓剂量较低的优势。
