Catheter-based Thrombus Removal in COVID-19 Patients with Acute Pulmonary Embolism

Purpose: Severe acute respiratory syndrome-associated coronavirus-2 (SARSCoV-2) virus, which causes COVID-19, is associated with a hypercoagulable state and high rates of pulmonary embolism (PE). The Centers for Disease Control and Prevention currently has no recommendations on use of catheter-based thrombus removal to treat PE. We review the literature and present two cases of COVID-19–associated acute PE that were successfully treated with novel pharmacomechanical catheter-directed thrombolysis (PCDT) using the BASHIR Endovascular Catheter (BEC).

Materials and Methods: A 50-year-old woman with a history of type 2 diabetes mellitus, hypertension, and morbid obesity presented with acute progressive dyspnea, pleuritic chest pain, and presyncope as well as hypoxia requiring 3 L of oxygen and a recent positive COVID nasopharyngeal swab. The second case was a 39-year-old woman who presented with worsening cough, dyspnea, and a syncopal episode with a new oxygen requirement of 5 L/min and a positive COVID nasopharyngeal swab result. Both patients underwent computed tomography angiography of the chest, which confirmed bilateral intermediate high-risk PE. Both patients had elevated troponins, lactic acid, and right ventricular dilation on echocardiogram. The Pulmonary Embolism Response Team (PERT) was consulted, and it was decided to proceed with pharmacomechanical CDT with BECs.

Results: After PCDT, the patients’ oxygen requirement, lactic acidosis, and kidney injury all resolved or improved. The first patient was in the intensive care unit (ICU) for 12 hours, and the second patient was in the ICU for 27 hours. Both were sent to the floors without need for supplemental oxygen and were discharge on day 4 of their hospitalization. We will discuss the literature review of all seven patients with COVID-19–related PE that have been reported to date.

Conclusions: This case series suggests that catheter-based therapies such as CDT are a viable treatment option for patients with COVID-19 with intermediate-risk PE and may even reduce length of ICU and hospital stay.