Cardiology Division, University Hospital, Geneva, Switzerland.
EuroIntervention. 2013 Apr 22;8(12):1419-27. doi: 10.4244/EIJV8I12A215.
Pulmonary embolism (PE) associated with haemodynamic instability has exceedingly high mortality. While intravenous thrombolysis is considered the therapy of choice, percutaneous mechanical thrombectomy may represent an alternative treatment.
The impact of AngioJet® rheolytic thrombectomy (RT) in PE associated with cardiogenic shock was assessed in a single-centre prospective pilot study. Ten consecutive PE patients in cardiogenic shock were included in the study. Six patients had thrombolysis contraindications, eight were intubated before the RT procedure and six had experienced cardiac arrest prior to the RT procedure. The RT procedure was technically successful in all cases. The Miller index improved from 25 to 20 (p=0.002). The shock index decreased from 1.22 to 0.9 (p=0.129). Thrombolytic agents were administered during or after the procedure in four patients because of progressive clinical deterioration. Seven patients died in the first 24 hours: two from multi-organ failure, one from post-anoxic cerebral oedema, and four from progressive right heart failure. The three survivors had favourable outcomes at one year.
This study suggests that the AngioJet® RT procedure may be safely performed in PE patients with cardiogenic shock. However, despite angiographic and haemodynamic improvements, the procedure does not appear to influence the dismal prognosis of these high-risk patients.
与血流动力学不稳定相关的肺栓塞（PE）死亡率极高。虽然静脉溶栓被认为是首选治疗方法，但经皮机械血栓切除术可能是一种替代治疗方法。
在一项单中心前瞻性试点研究中评估了 AngioJet®射流血栓切除术（RT）在伴有心源性休克的 PE 中的作用。该研究纳入了 10 例连续伴有心源性休克的 PE 患者。6 例患者存在溶栓禁忌证，8 例在 RT 术前插管，6 例在 RT 术前发生心脏骤停。所有病例的 RT 手术均获得技术成功。米勒指数从 25 改善至 20（p=0.002）。休克指数从 1.22 降低至 0.9（p=0.129）。由于临床恶化，4 例患者在术中或术后使用了溶栓药物。24 小时内 7 例患者死亡：2 例死于多器官衰竭，1 例死于缺氧性脑水肿，4 例死于进行性右心衰竭。3 例存活患者在 1 年内预后良好。
本研究表明，AngioJet® RT 手术可安全用于伴有心源性休克的 PE 患者。然而，尽管血管造影和血流动力学得到改善，但该手术似乎并不能影响这些高危患者的不良预后。
