Obstructive Shock Pulmonary Embolism: Catheter Directed Thrombolysis

Venous thromboembolism is one of the most frequently encountered condition for which patients need intensive care admission often. Most of the time patients presents with shock and hemodynamic instability if it is massive pulmonary embolism. Incidence of Vte is comparable to western population in India, studies conducted by Ayyapan et all say it around 20/10,000 admission. Studies showed higher mortality of around 50% in high risk (massive) and mortality of around 14% in intermediate risk (sub-massive) PE which necessitating more aggressive approach in high-risk groups. Rapid administration of systemic thrombolytic agents is indicated in massive pulmonary embolism patients who presents with hemodynamic instability but systemic thrombolytic therapy is associated with risk of major bleeding around 20% and haemorrhagic stroke of 2% to 5% . During systemic thrombolysis shunting of thrombolytic agents away from clot into the systemic circulation which makes it failed lysis sometimes along with major bleeding.