卵圆孔未闭患者肺栓塞的机械取栓术
Mechanical thrombectomy for pulmonary embolism in patients with patent foramen Ovale.
作者信息
Nezami Nariman, Chockalingam Arun, Cornman-Homonoff Joshua, Marino Angelo, Pollak Jeffrey, Mojibian Hamid
机构信息
Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
Division of Vascular and Interventional Radiology, Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
CVIR Endovasc. 2020 Nov 28;3(1):89. doi: 10.1186/s42155-020-00180-9.
BACKGROUND
The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited.
RESULTS
This was a retrospective analysis of 9 patients with PFO and acute high-risk or intermediate-high-risk PE, 6 with intermediate-high risk and 3 with high-risk PE. All underwent MT using the Inari FlowTriever System from Dec 2018 to November 2019. Six of these patients had confirmed deep venous thrombosis. The technical and clinical success rate for MT in all patients was 100% and 77.8%, respectively. Right-heart strain improved in 6/8 patients on follow-up echocardiography. Mean main pulmonary artery (MPA) pressure significantly decreased after MT (p < 0.012). One patient presented with altered mental status (somnolence and disorientation) prior to coronary artery angiogram and thrombectomy, developed a middle cerebral artery embolic stroke 1 day after MT, and recovered with minor sequalae and later was discharged. There was no in-hospital mortality.
CONCLUSIONS
MT using FlowTriever was feasible and safe, successfully improving MPA pressure in patients presenting with concurrent PFO and PE.
背景
对于卵圆孔未闭（PFO）患者的肺栓塞（PE）进行机械血栓切除术（MT）的当前证据水平有限。
结果
这是一项对9例PFO合并急性高危或中高危PE患者的回顾性分析，其中6例为中高危PE，3例为高危PE。所有患者在2018年12月至2019年11月期间均使用Inari FlowTriever系统进行了MT。这些患者中有6例确诊为深静脉血栓形成。所有患者MT的技术成功率和临床成功率分别为100%和77.8%。在随访超声心动图检查中，8例患者中有6例右心劳损得到改善。MT后平均主肺动脉（MPA）压力显著降低（p < 0.012）。1例患者在冠状动脉造影和血栓切除术之前出现精神状态改变（嗜睡和定向障碍），MT后1天发生大脑中动脉栓塞性中风，恢复后有轻微后遗症，随后出院。无院内死亡。
结论
使用FlowTriever进行MT是可行且安全的，成功改善了合并PFO和PE患者的MPA压力。
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