Uecker Nicola Anne, Rosenkranz Stephan, Bunck Alexander, Tichelbäcker Tobias
Faculty of Medicine and University Hospital Cologne, Clinic for Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany.
Faculty of Medicine and University Hospital Cologne, Department of Radiology, University of Cologne, Kerpener Str. 62, 50937 Cologne, NRW, Germany.
Eur Heart J Case Rep. 2023 Feb 13;7(3):ytad074. doi: 10.1093/ehjcr/ytad074. eCollection 2023 Mar.
The optimal therapy for patients suffering from acute pulmonary embolism (PE) classified as intermediate-high risk still needs to be identified. Catheter-directed thrombectomy (CDTE) is a safe procedure to reduce thrombus burden immediately. The lack of randomized trials is one reason: catheter-directed thrombolysis (CDT) has not yet received a clear recommendation in our guidelines. Herein, we report an unexpected event in the course of a patient with PE treated with CDTE using the FlowTriever™ system, the only FDA-approved catheter system for percutaneous mechanical thrombectomy regarding this indication.
A 57-year-old male presented with dyspnoea at the emergency department of our university hospital. The computed tomography (CT) scan showed bilateral PE, and ultrasound of the left lower limb revealed deep venous thrombosis. According to the current ESC guidelines, he was classified intermediate-high risk. We performed bilateral CDTE. On the first and third day post-intervention, our patient presented neurological deficits. Whereas the first CT scan of the cerebrum remained normal, the CT scan at Day 3 showed demarcated embolic stroke. Further imaging diagnostic gave evidence to an ischemic lesion in the left kidney. Transesophageal echocardiography revealed a patent foramen ovale (PFO) as the origin of paradoxical embolism and thus mechanism of both ischemic lesions. Compliant to the current recommendations, percutaneous PFO closure was performed. Our patient recovered properly without any sequelae.
Whether the deep venous thrombosis is the source of embolization or the catheter-directed retrieval of clots may have transported clot material to the right atrium which further on embolized systemically will remain unclear. Yet, we have to consider it as a potential complication in catheter-directed treatment of PE in patients with a PFO.
对于被归类为中高危的急性肺栓塞（PE）患者，最佳治疗方案仍有待确定。导管直接血栓切除术（CDTE）是一种能立即减轻血栓负荷的安全手术。缺乏随机试验是原因之一：导管直接溶栓术（CDT）在我们的指南中尚未得到明确推荐。在此，我们报告一例使用FlowTriever™系统进行CDTE治疗的PE患者过程中发生的意外事件，FlowTriever™系统是美国食品药品监督管理局（FDA）批准的唯一用于该适应症经皮机械血栓切除术的导管系统。
一名57岁男性因呼吸困难就诊于我校医院急诊科。计算机断层扫描（CT）显示双侧PE，左下肢超声显示深静脉血栓形成。根据当前欧洲心脏病学会（ESC）指南，他被归类为中高危。我们进行了双侧CDTE。在干预后的第一天和第三天，我们的患者出现神经功能缺损。虽然第一次脑部CT扫描结果正常，但第三天的CT扫描显示有明确的栓塞性中风。进一步的影像学诊断证实左肾有缺血性病变。经食管超声心动图显示卵圆孔未闭（PFO）是反常栓塞的起源，也是两个缺血性病变的机制。按照当前建议，进行了经皮PFO封堵术。我们的患者恢复良好，没有任何后遗症。
深静脉血栓形成是否是栓塞的来源，或者导管直接取栓是否可能已将血栓物质输送至右心房，进而发生全身栓塞，仍不明确。然而，我们必须将其视为PFO患者导管直接治疗PE时的一种潜在并发症。
