Pizano Alejandro, Ray Hunter M, Cambiaghi Tommaso, Saqib Naveed U, Afifi Rana, Khan Sophia, Martin Gordon, Harlin Stuart A
McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA -
McGovern Medical School, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
J Cardiovasc Surg (Torino). 2022 Apr;63(2):222-228. doi: 10.23736/S0021-9509.21.12081-6. Epub 2021 Nov 26.
Submassive and massive pulmonary embolism is associated with a high risk of complications. We aimed to evaluate our initial experience with a mechanical thrombectomy device in the management of these patients.
A single-center, retrospective study was performed in patients with acute submassive and massive pulmonary embolism treated with the FlowTriever device (Inari Medical, Irvine, CA, USA) between June 2019 and November 2020. Clinical and technical parameters were analyzed during the hospitalization and at 30- and 180-days after the procedure.
Fourteen patients were evaluated with a median (IQR) age of 60 (50-69) years and 64% were male. All had right heart strain as the main indication for thrombectomy. The procedure duration and fluoroscopic time was 52 (37-89) and 13 (9-24) minutes, respectively. There was 100% technical success, and the pulmonary arterial pressure went from 60 (48-65) mmHg to 40 (34-47) mmHg. Thrombolysis was used in two patients and nine patients required intensive care. 100% experienced improvement in symptoms at the time of discharge. There were no device-related complications, major bleeding events, myocardial infarctions, or deaths. Preprocedural hemoglobin was 13 (12-15) g/dL, and predischarge was 12 (10-13) g/dL. Overall postprocedural length of stay was three (2-6) days. All the patients were discharged with oral anticoagulation. There were no device-related complications or recurrence of embolism at 30 and 180 days.
The mechanical thrombectomy device for submassive and massive pulmonary embolism is promising and appears a safe and effective procedure with 100% technical success, no complications, short intensive care requirement/stay, and good early clinical outcomes.
亚大面积和大面积肺栓塞与高并发症风险相关。我们旨在评估使用机械血栓清除装置治疗这些患者的初步经验。
对2019年6月至2020年11月期间使用FlowTriever装置（美国加利福尼亚州欧文市Inari Medical公司）治疗的急性亚大面积和大面积肺栓塞患者进行了一项单中心回顾性研究。分析了住院期间以及术后30天和180天时的临床和技术参数。
评估了14例患者，中位（四分位间距）年龄为60（50 - 69）岁，64%为男性。所有患者均以右心劳损作为血栓清除术的主要指征。手术时间和透视时间分别为52（37 - 89）分钟和13（9 - 24）分钟。技术成功率为100%，肺动脉压从60（48 - 65）mmHg降至40（34 - 47）mmHg。2例患者使用了溶栓治疗，9例患者需要重症监护。100%的患者在出院时症状有所改善。未发生与装置相关的并发症、大出血事件、心肌梗死或死亡。术前血红蛋白为13（12 - 15）g/dL，出院前为12（10 - 13）g/dL。术后总体住院时间为3（2 - 6）天。所有患者均口服抗凝剂出院。在30天和180天时未发生与装置相关的并发症或栓塞复发。
用于亚大面积和大面积肺栓塞的机械血栓清除装置前景广阔，似乎是一种安全有效的手术，技术成功率达100%，无并发症，重症监护需求/住院时间短，且早期临床效果良好。
