Department of Cardiovascular Sciences, Sapienza University, Viale del Policlinico 155, 00166 Rome, Italy.
J Invasive Cardiol. 2020 Nov;32(11):412-416. doi: 10.25270/jic/20.00173.
Percutaneous rheolytic thrombectomy is an attractive alternative to thrombolytic therapy in patients with acute pulmonary embolism (PE), but its use is currently discouraged due to safety concerns.
We studied 33 consecutive patients (age, 43 ± 13 years; 20 men and 13 women) with acute PE and contraindications to thrombolytic therapy who had rheolytic thrombectomy with the AngioJet catheter (Boston Scientific). Acute massive PE was initially diagnosed by computed tomography and then confirmed by pulmonary angiography. Pulmonary thrombus location was evaluated prior to the procedure. Anemia was defined as a decrease in hematocrit level <39% for men and <36% for women. Renal failure was defined as oliguria (urine output <500 mL/24 hours) or an increase in creatinine (>25% over baseline or an overall increase by 1 g/dL).
Catheter thrombectomy resulted in angiographic improvement in 32 patients (96%), with a rapid amelioration in functional class (from 3.3 ± 0.9 to 2.1 ± 0.7; P<.001) and an increase in oxygen saturation (from 71 ± 15% to 92 ± 17%; P<.001). No patient died. Side effects included transient heart block (n = 1), hypotension (n = 3), and bradycardia (n = 5). Anemia occurred in 4 patients, while renal failure was not detected. Clinical improvement was maintained during follow-up. At 1 year, systolic pulmonary pressure was significantly lower than at baseline (65 ± 31 mm Hg vs 31 ± 19 mm Hg; P<.001).
Catheter thrombectomy with AngioJet in patients with acute massive PE and contraindications to thrombolysis is an effective therapeutic alternative that is not associated with relevant and persistent side effects, including the risk of death or developing anemia and renal failure.
经皮旋切血栓切除术是急性肺栓塞（PE）患者溶栓治疗的一种有吸引力的替代方法，但由于安全性问题，目前不鼓励使用。
我们研究了 33 例连续的急性 PE 患者（年龄 43±13 岁；20 名男性，13 名女性），这些患者因存在溶栓治疗禁忌证而采用 AngioJet 导管（波士顿科学公司）进行旋切血栓切除术。急性大面积 PE 最初通过计算机断层扫描诊断，然后通过肺动脉造影确认。在手术前评估肺血栓位置。贫血定义为男性的血细胞比容水平降低<39%，女性降低<36%。肾衰竭定义为少尿（尿量<500 mL/24 小时）或肌酐升高（比基线升高>25%或总体升高 1 g/dL）。
导管血栓切除术使 32 例患者（96%）的血管造影得到改善，心功能分级迅速改善（从 3.3±0.9 改善至 2.1±0.7；P<.001），氧饱和度增加（从 71±15%增加至 92±17%；P<.001）。没有患者死亡。副作用包括短暂性心脏传导阻滞（n=1）、低血压（n=3）和心动过缓（n=5）。4 例患者出现贫血，而未发现肾衰竭。随访期间临床改善持续存在。在 1 年时，收缩压肺压明显低于基线（65±31 mm Hg 比 31±19 mm Hg；P<.001）。
对于溶栓治疗禁忌的急性大面积 PE 患者，采用 AngioJet 导管血栓切除术是一种有效的治疗选择，不会引起明显且持续的副作用，包括死亡风险或发生贫血和肾衰竭的风险。
