Pieraccini Massimo, Guerrini Susanna, Laiolo Edoardo, Puliti Alessio, Roviello Giandomenico, Misuraca Leonardo, Spargi Genni, Limbruno Ugo, Breggia Mauro, Grechi Morando
Department of Diagnostic Imaging and Laboratory Medicine, Vascular and Interventional Radiology Unit, Azienda USL Toscana SUD-EST, Misericordia Hospital, Via Senese, 1, 58100, Grosseto, Italy.
Department of Diagnostic Imaging and Laboratory Medicine, Diagnostic Imaging Unit, Azienda USL Toscana SUD-EST, Misericordia Hospital, 58100, Grosseto, Italy.
Cardiovasc Intervent Radiol. 2018 Dec;41(12):1840-1848. doi: 10.1007/s00270-018-2011-3. Epub 2018 Jul 6.
The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis.
Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51-87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score.
Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2-12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence.
The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.
本研究旨在评估抽吸机械血栓切除术在大面积和次大面积肺栓塞（PE）且有溶栓禁忌证患者中的可行性。
2016年10月至2017年11月期间前瞻性纳入了18例出现大面积（8/18）或次大面积（10/18）PE的患者。所有纳入患者均有溶栓禁忌证（出血性卒中n = 1，既往6个月内缺血性卒中n = 7，中枢神经系统损伤或肿瘤n = 1，既往3周内近期重大创伤/手术/头部损伤n = 5，过去1个月内胃肠道出血n = 4）。18例患者中8例（44.44%）为女性，10例（55.55%）为男性，平均年龄74.76岁（范围51 - 87岁）。所有患者均根据肺栓塞严重程度指数（PESI）和简化PESI评分进行分层。
根据介入放射学会报告标准定义，18例患者（100%）实现了技术和操作成功，而18例患者中有14例（78%）实现了临床成功，术前和术后右心室/左心室（RV/LV）比值、肺氧饱和度（SpO）、心率、肺动脉收缩压和米勒评分均有显著改善，p值分别一致<0.00001、0.01、0.001、<0.00001和<0.00001。重症监护病房的中位住院天数为8.35天（范围2 - 12天），在随访期间，没有患者发生肺动脉高压或PE复发。
本研究中所采用手术的高技术和临床成功率表明，单独使用抽吸机械血栓切除术是一种有前景的技术。需要更广泛的前瞻性研究来评估这种治疗的可行性。
