Agarwal Siddharth, Saum Jamie, Chanamalou Sreenivasa, Cole William, Patel Sandeep M
Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Structural Heart and Intervention Center, St. Rita's Medical Center, Lima, OH, USA.
J Cardiol Cases. 2020 Oct 22;23(2):57-60. doi: 10.1016/j.jccase.2020.10.002. eCollection 2021 Feb.
Percutaneous mechanical thrombectomy devices have revolutionized the treatment of massive pulmonary embolism (PE) by providing a rapid, non-thrombolytic based method to re-establish right-sided circulation while reducing bleeding complications. However, with massive PE, the acute increase in right ventricular afterload results in a compounded hemodynamic compromise, which may necessitate the need for advanced cardiac support. This case exemplifies the need for a comprehensive and synergistic approach to the management of massive PE. To our knowledge, this is the first report of combination therapy using large bore mechanical suction thrombectomy (FlowTriever, INARI Medical, Irvine, CA, USA) in conjunction with the implantation of right ventricular mechanical support (Impella RP, ABIOMED, Danvers, MA, USA) in an effort to reverse the right ventricular "shock spiral." < To understand the importance of timely intervention in massive pulmonary embolism (PE) and the role of percutaneous mechanical thrombectomy devices in such situations where thrombolysis fails or is contraindicated. To incorporate the simultaneous use of mechanical circulatory support in the setting of massive PE.>.
经皮机械血栓清除装置通过提供一种快速、非溶栓的方法来重建右侧循环，同时减少出血并发症，彻底改变了大面积肺栓塞（PE）的治疗方式。然而，对于大面积PE，右心室后负荷的急性增加会导致复合性血流动力学损害，这可能需要先进的心脏支持。本病例说明了对大面积PE进行综合协同管理的必要性。据我们所知，这是首例联合使用大口径机械抽吸血栓清除术（FlowTriever，INARI Medical，美国加利福尼亚州欧文市）与植入右心室机械支持装置（Impella RP，ABIOMED，美国马萨诸塞州丹弗斯市）以逆转右心室“休克螺旋”的联合治疗报告。<了解及时干预大面积肺栓塞（PE）的重要性以及经皮机械血栓清除装置在溶栓失败或禁忌的情况下所起的作用。在大面积PE的情况下采用机械循环支持的同时使用方法。>
