Bigdelu Leila, Ebrahimi Negar, Maadarani Ossama
Division of Cardiovascular Medicine, Vascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Student Research Committee, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.
Eur J Case Rep Intern Med. 2023 Aug 25;10(9):004042. doi: 10.12890/2023_004042. eCollection 2023.
Acute pulmonary thromboembolism (PTE) is considered the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke, with annual incidence rates ranging from 39 to 115 per 100,000 people and ranking high among the causes of cardiovascular mortality. High-risk PTE is characterised by haemodynamic instability and encompasses clinical manifestations such as cardiac arrest, obstructive shock and persistent hypotension. The European Society of Cardiology (ESC) recommends a reperfusion strategy with systemic thrombolytic therapy for high-risk PTE under class I, level B if there are no contraindications. Overall, unsuccessful thrombolytic therapy and recurrent PTE have been reported in 8% of patients with high-risk PTE. The guidelines recommend surgical pulmonary embolectomy if thrombolysis is contraindicated or has failed. The position of repeated thrombolytic therapy as a treatment option in patients with recurrent high-risk PTE, especially in situations with a lack of surgical expertise or resources, was not mentioned in the guidelines. We report the case of a patient who suffered a recurrent high-risk PTE and was treated with repeated thrombolytic therapy that was effective and resulted in excellent outcomes.
Acute pulmonary thromboembolism (PTE) is a serious medical condition and widespread disease with well-recognised morbidity and mortality.Systemic thrombolytic therapy should be the first choice in patients with high-risk PTE without contraindication.Repeated thrombolytic therapy in recurrent high-risk PTE might be effective in patients with low risk of bleeding as an alternative to surgical embolectomy or catheter-directed therapy.
急性肺血栓栓塞症（PTE）被认为是仅次于心肌梗死和中风的第三常见急性心血管综合征，年发病率为每10万人39至115例，在心血管死亡原因中排名靠前。高危PTE的特征是血流动力学不稳定，包括心脏骤停、梗阻性休克和持续性低血压等临床表现。欧洲心脏病学会（ESC）建议，对于无禁忌证的高危PTE患者，在I类B级推荐采用全身溶栓治疗的再灌注策略。总体而言，8%的高危PTE患者报告有溶栓治疗失败和复发性PTE。指南建议，如果溶栓治疗禁忌或失败，则进行外科肺动脉血栓切除术。指南未提及重复溶栓治疗作为复发性高危PTE患者治疗选择的地位，尤其是在缺乏手术专业知识或资源的情况下。我们报告了一例复发性高危PTE患者的病例，该患者接受了重复溶栓治疗，治疗有效且预后良好。
急性肺血栓栓塞症（PTE）是一种严重的医学疾病，发病率和死亡率高，广泛存在。对于无禁忌证的高危PTE患者，全身溶栓治疗应作为首选。对于复发性高危PTE患者，重复溶栓治疗对于出血风险低的患者可能有效，可作为外科血栓切除术或导管定向治疗的替代方法。
