Hoster Clay H, Herring Michael J, Planek Maria Isabel C, Attanasio Steve
Internal Medicine, Rush University Medical Center, Chicago, USA.
Cardiovascular Medicine, Rush University Medical Center, Chicago, USA.
Cureus. 2020 Aug 19;12(8):e9874. doi: 10.7759/cureus.9874.
A 79-year-old male presented with an acute stroke and was treated with tissue plasminogen activator (tPA). His neurological symptoms improved, but he subsequently developed hemodynamic instability requiring intubation and vasopressors. Imaging studies revealed a massive pulmonary embolism as the cause of his worsening clinical picture. Mechanical thrombectomy using traditional devices was deemed too risky as the patient could not safely tolerate the usual anticoagulation dosage these devices require. The Penumbra Indigo® system (Alameda, CA, USA) was thus chosen for its ability to achieve thrombus aspiration within a lower therapeutic heparin range. Pulmonary artery aspiration thrombectomy was done using the device, and three days after the procedure, he was extubated and weaned completely off vasopressors. The therapy's efficacy despite the patient's unique life-threatening conditions demonstrates a novel application of the state-of-the-art pulmonary embolism treatment currently in research.
一名79岁男性因急性中风接受组织型纤溶酶原激活剂（tPA）治疗。他的神经症状有所改善，但随后出现血流动力学不稳定，需要插管和使用血管升压药。影像学检查显示，大面积肺栓塞是其临床症状恶化的原因。由于患者无法安全耐受传统机械取栓设备所需的常规抗凝剂量，使用传统设备进行机械取栓被认为风险太大。因此，选择了Penumbra Indigo®系统（美国加利福尼亚州阿拉米达），因为它能够在较低的治疗性肝素范围内实现血栓抽吸。使用该设备进行了肺动脉抽吸血栓切除术，术后三天，他被拔除气管插管，并完全停用血管升压药。尽管患者处于独特的危及生命的状况，但该疗法的有效性证明了目前正在研究的最先进的肺栓塞治疗方法的一种新应用。
