Clinical Study
Aspiration Thrombectomy for Treatment of Acute Massive and Submassive Pulmonary Embolism: Initial Single-Center Prospective Experience

https://doi.org/10.1016/j.jvir.2017.08.010Get rights and content

Abstract

Purpose

To evaluate the feasibility of aspiration thrombectomy in patients with acute massive or submassive pulmonary embolism (PE).

Materials and Methods

This prospective study analyzed patient demographic data, procedural details, and outcomes in 18 consecutive patients (8 men and 10 women; mean age, 60.1 y; range, 36–80 y), 10 with acute submassive PE and 8 with massive PE, treated with an Indigo Continuous Aspiration Mechanical Thrombectomy Catheter between January 2016 and February 2017. Three patients underwent concomitant systemic fibrinolytic treatment with 100 mg tissue plasminogen activator. Technical success was defined as successful placement of devices and initiation of aspiration thrombectomy. Clinical success was defined as stabilization of hemodynamic parameters; improvement in pulmonary hypertension, right heart strain, or both; and survival to hospital discharge. Complications were also analyzed.

Results

The procedure was considered a technical success in 17 patients (94.4%) and a clinical success in 15 (83.3%). Echocardiography showed significant improvements in right ventricle size (46.36 mm ± 2.2 before treatment vs 41.79 mm ± 7.4 after; P = .041), tricuspid annular plane systolic excursion (16 ± 3 before treatment vs 18.57 ± 3.9 after; P = .011), and systolic wave (10 ± 2.1 before treatment vs 13.1 ± 3.8 after; P = .020). Two patients died of massive PE, and 1 died of submassive PE. Two patients who received systemic fibrinolytic agents experienced intracranial bleeding, and abdominal bleeding developed in 1.

Conclusions

Aspiration thrombectomy is a feasible option for the treatment of acute massive or submassive PE in patients with hemodynamic compromise or right ventricular dysfunction.

Section snippets

Materials and Methods

The institutional review board approved this prospective study. Between January 2016 and February 2017, all consecutive patients aged ≥ 18 years presenting within 7 days of onset of symptoms of acute massive or submassive PE who had computed tomography (CT) findings compatible with proximal PE were eligible for first-line treatment with aspiration thrombectomy. The study included 18 patients (age range, 36–80 y; 8 [44.4%] men), 6 of whom (33.3%) were obese (body mass index > 31 kg/m2) and 1 of

Results

Continuous aspiration mechanical thrombectomy was the first-line treatment in 18 patients, and the procedure was a technical success in 17 (94.4%); 1 patient died during the procedure. Fibrinolysis with TPA was used in 4 patients (22.2%), being administered systemically (100 mg TPA) in 3 and locally (4 mg TPA) in the other. The mean duration of the procedure (ie, fluoroscopy time) was 85 minutes (range, 71–100 min). Thrombus reduction during the procedure was classified as complete or nearly

Discussion

The incidence of fatal PE seems to have decreased in recent years, probably in relation to early diagnosis and prophylactic measures 1, 2. Aspiration thrombectomy is a relatively new treatment approach for PE, and the results reported here provide an initial picture of the outcomes of pulmonary mechanical aspiration thrombectomy with the Indigo catheter in patients with massive and submassive PE. The high rates of technical success (94.4%) and clinical success (83.3%) suggest this approach is

References (22)

Cited by (36)

  • Complications of Penumbra Indigo Aspiration Device in Pulmonary Embolism: Insights From MAUDE Database

    2022, Cardiovascular Revascularization Medicine
    Citation Excerpt :

    Another study used the device in 18 patients with acute PE. Overall, three patients (16.7%) died and three patients (16.7%) suffered from bleeding, and all of them received systemic thrombolysis before embolectomy. [12] The EXTRACT-PE (Evaluating the Safety and Efficacy of the Indigo aspiration system in Acute Pulmonary Embolism) trial evaluated the 8F Penumbra Indigo system in 119 patients with symptomatic acute PE.

View all citing articles on Scopus

None of the authors have identified a conflict of interest.

View full text