Outcomes of Pharmacomechanical Thrombectomy for Patients Presenting with High-Risk Pulmonary Embolism

Purpose: To assess outcomes after pharmacomechanical thrombectomy for patients presenting with high risk-pulmonary embolism (PE)

Materials and Methods: From April 2017 to July 2019, 12 patients (8 males, 4 females; mean age, 62 years) underwent pharmacomechanical thrombectomy for high-risk PE after multidisciplinary pulmonary emergency response team discussion. Four patients had a contraindication to systemic anticoagulation, and five patients had a contraindication to surgery. A retrospective chart review provided demographic data, medical history, procedural information, and complications.

Results: Eleven patients underwent thrombectomy using the Penumbra Cat8 Suction thrombectomy device. In one case, mechanical thrombectomy was performed using a pigtail catheter spin technique. An average of 13.5 mg (2–30 mg) of local tissue plasminogen activator (tPA) was administered in 11 cases. In 3 of these cases, infusion catheters were placed for a tPA infusion (1 mg/hr for 24 hours) after thrombectomy. Each patient was also treated with a therapeutic heparin drip. There was a mean drop of 11.1 mm Hg in systolic pulmonary artery pressure after the intervention. There were 2 major complications (1 intraprocedure cardiac arrest with resuscitation, 1 intracranial bleed). After treatment, 6 of 12 patients recovered and were discharged after a mean hospital stay of 4.5 days (2–8 days). Six patients died during the hospital stay, but only 4 deaths were attributed to PE or right heart failure.

Conclusions: In patients who have a contraindication to systemic lysis or surgery, pharmacomechanical thrombectomy may be a lifesaving procedure and should be considered.