Safety and efficacy of percutaneous mechanical thrombectomy in the treatment of acute medium- or high-risk pulmonary embolism: a single-center retrospective cross-sectional study.
{"title":"Safety and efficacy of percutaneous mechanical thrombectomy in the treatment of acute medium- or high-risk pulmonary embolism: a single-center retrospective cross-sectional study.","authors":"Fei Li, Zhengxian Su, Chuntao Fu, Qing Wang, Xiang Wang, Jiecheng Zhang, Masahiro Yanagiya, Wenjun Zhao","doi":"10.21037/jtd-24-1690","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with acute and high-risk pulmonary embolism have a high mortality rate, and the optimal treatment for these patients has still not been fully established. Although anticoagulation therapy is currently the preferred treatment for pulmonary embolism, for some patients with intermediate- or high-risk pulmonary embolism, anticoagulation therapy alone has a higher probability of long-term pulmonary hypertension and also seriously worsens the quality of life of patients. This paper mainly reports the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in patients with acute medium- or high-risk pulmonary embolism in Taizhou Hospital of Zhejiang Province so as to provide some clinical basis for the treatment of such patients in the future.</p><p><strong>Methods: </strong>This study mainly collected the clinical data of 43 patients who were admitted to Taizhou Hospital of Zhejiang Province from May 2018 to May 2023 due to acute medium-to-high-risk pulmonary embolism and received PMT treatment. Preoperative and postoperative blood tests, vital signs, and echocardiographic parameters were compared. The incidence of intraoperative and postoperative complications in follow-up at 1, 6, and 12 months was also recorded. Mechanical treatment included thrombus fragmentation complemented with aspiration.</p><p><strong>Results: </strong>Among the 43 patients, 22 patients were treated with thrombus fragmentation coupled with a pigtail catheter and aspiration using a 6-F multipurpose angiographic (MPA) catheter, 11 were treated by AngioJet, and 10 were treated with an AcoStream catheter. Local thrombolysis treatment with small dose of urokinase was administered in some patients according to the patient's risk of bleeding. Among the patients, 41 patients received a successful operation, representing a surgical success rate of 95.3%. There was one patient with pulmonary infection who died after discharge. There were significant differences in vital signs between the 48-hour preoperative timepoint and the 48-hour postoperative timepoint including cardiac index, pulse, mean arterial pressure, and oxygen saturation (P<0.001). The blood test indicators of carbon dioxide partial pressure and creatinine level did not show obvious abnormalities, but differences in hemoglobin, oxygen partial pressure, and lactate level were statistically significant. In terms of cardiac ultrasound, pulmonary artery pressure and right atrial diameter change were significantly different (P<0.001). There were seven cases of local hematoma at the puncture site, three cases of infection at the puncture site, and nine cases of transient cardiac arrest during the operation. All 41 patients were followed up: one patient died after being discharged due to aggravation of pulmonary infection during hospitalization, one patient died of intracerebral hemorrhage 9 months after the operation, one patient developed recurrent pulmonary embolism, and five patients had no obvious improvement in chest tightness.</p><p><strong>Conclusions: </strong>PMT can be used as a safe and effective treatment option for acute medium-to-high-risk pulmonary embolism.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7797-7806"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635266/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-1690","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/29 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Patients with acute and high-risk pulmonary embolism have a high mortality rate, and the optimal treatment for these patients has still not been fully established. Although anticoagulation therapy is currently the preferred treatment for pulmonary embolism, for some patients with intermediate- or high-risk pulmonary embolism, anticoagulation therapy alone has a higher probability of long-term pulmonary hypertension and also seriously worsens the quality of life of patients. This paper mainly reports the efficacy and safety of percutaneous mechanical thrombectomy (PMT) in patients with acute medium- or high-risk pulmonary embolism in Taizhou Hospital of Zhejiang Province so as to provide some clinical basis for the treatment of such patients in the future.
Methods: This study mainly collected the clinical data of 43 patients who were admitted to Taizhou Hospital of Zhejiang Province from May 2018 to May 2023 due to acute medium-to-high-risk pulmonary embolism and received PMT treatment. Preoperative and postoperative blood tests, vital signs, and echocardiographic parameters were compared. The incidence of intraoperative and postoperative complications in follow-up at 1, 6, and 12 months was also recorded. Mechanical treatment included thrombus fragmentation complemented with aspiration.
Results: Among the 43 patients, 22 patients were treated with thrombus fragmentation coupled with a pigtail catheter and aspiration using a 6-F multipurpose angiographic (MPA) catheter, 11 were treated by AngioJet, and 10 were treated with an AcoStream catheter. Local thrombolysis treatment with small dose of urokinase was administered in some patients according to the patient's risk of bleeding. Among the patients, 41 patients received a successful operation, representing a surgical success rate of 95.3%. There was one patient with pulmonary infection who died after discharge. There were significant differences in vital signs between the 48-hour preoperative timepoint and the 48-hour postoperative timepoint including cardiac index, pulse, mean arterial pressure, and oxygen saturation (P<0.001). The blood test indicators of carbon dioxide partial pressure and creatinine level did not show obvious abnormalities, but differences in hemoglobin, oxygen partial pressure, and lactate level were statistically significant. In terms of cardiac ultrasound, pulmonary artery pressure and right atrial diameter change were significantly different (P<0.001). There were seven cases of local hematoma at the puncture site, three cases of infection at the puncture site, and nine cases of transient cardiac arrest during the operation. All 41 patients were followed up: one patient died after being discharged due to aggravation of pulmonary infection during hospitalization, one patient died of intracerebral hemorrhage 9 months after the operation, one patient developed recurrent pulmonary embolism, and five patients had no obvious improvement in chest tightness.
Conclusions: PMT can be used as a safe and effective treatment option for acute medium-to-high-risk pulmonary embolism.
期刊介绍:
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.