Intravascular ultrasound-guided catheter-based aspiration thrombectomy in patients with acute submassive pulmonary embolism: A case series.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
Gautam KumarRajesh Sachdeva

Abstract

Contrast pulmonary angiography by hand injection or power injection is widely used during catheter-based therapies for acute submassive and massive pulmonary embolism (PE). Particularly, in patients with pre-existing chronic kidney disease, this approach may present a prognostic challenge owing to a double-contrast load, initially during computed tomographic pulmonary angiography (CTPA), and during percutaneous treatment. Intravascular ultrasound (IVUS) has been used as an adjunctive imaging modality in the percutaneous treatment of chronic thromboembolic pulmonary hypertension, and in coronary and peripheral vascular interventions. We report a series of cases illustrating the use of IVUS in the management of acute PE. All five patients presented with an acute submassive PE with evidence of right ventricular (RV) strain (RV/LV ratio ≥ 0.90). Body mass index and B-type natriuretic peptide ranged from 18 to 47 kgm/m2 and 56-932 pg/mL (ref. ≤ 78), respectively. Three of the five patients had renal impairment prior to the procedure (acute kidney injury, AKI, and chronic kidney injury, CKD). Post-catheter-directed pulmonary embolectomy there was a modest reduction in mean pulmonary artery pressure in all five patients (range: -4 mmH...Continue Reading

References

Nov 30, 2012·Circulation. Cardiovascular Interventions·Hiroki MizoguchiHiromi Matsubara
Mar 19, 2016·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Nobutaka IkedaYukio Hiroi
May 31, 2019·International Journal of Cardiology·Martin MurgierUNKNOWN RIETE Investigators
May 21, 2020·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Valery S EffoeRajesh Sachdeva

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