Combined catheter thrombus fragmentation and fibrinolysis for acute pulmonary embolism

Aims: The aim of this study is to evaluate the effectiveness and safety of combinedcatheter thrombus fragmentation and fibrinolysis for acute pulmonary embolism (PE).Methods: Forty-six patients (19 men and 27 women, average age 52.3 -- CORRECTION REQUIRED HERE -- 2; 13.4 years)with acute PE and right ventricular dysfunction were treated by mechanical thrombusfragmentation with a percutaneous transluminal coronary angioplasty guide catheter.Urokinase was injected into the culprit pulmonary artery after catheter thrombusfragmentation in all patients.Result: Clinical success was achieved in all patients. After the treatment, the averagepulmonary artery pressure was decreased from 57.2 -- CORRECTION REQUIRED HERE -- 2; 6.2 to 36.3 -- CORRECTION REQUIRED HERE -- 2; 4.1 mmHg (P <0.01). The oxygen saturation rate was raised from 81.4 -- CORRECTION REQUIRED HERE -- 2; 4.3% to 97.0 -- CORRECTION REQUIRED HERE -- 2; 2.0% (P <0.01), and the right ventricular function was improved. There was no in-hospitalmortality and there were no major complications, such as haemorrhage. Patients weretreated with warfarin for 6 months with no signs of PE recurrence during the follow up.Conclusion: In PE patients with right ventricular dysfunction and unstable haemodynamics,combined catheter thrombus fragmentation and thrombolysis appears to be auseful therapeutic strategy. In PE patients with right ventricular dysfunction and stablehaemodynamics, randomized trials are still required to show that combination ofcatheter-directed thrombus fragmentation and thrombolysis is superior to standardanticoagulation.