Changes in Lung Perfusion in Patients Treated with Percutaneous Mechanical Thrombectomy for Intermediate-Risk Pulmonary Embolism - 29/07/22
, Vruksha Upadhyay, MD b, Maruti Kumaran, MD c, Riyaz Bashir, MD d, Vladimir Lakhter, DO d, Joseph Panaro, MD e, Gerard Criner, MD a, Simin Dadparvar, MD c, Parth Rali, MD aAbstract |
Background |
Current pulmonary embolism treatment options rely heavily on anatomical clot location. However, anatomical location does not necessarily determine adverse outcomes; rather, clinical severity is secondary to the degree of perfusion impairment. Dual-energy computed tomography pulmonary angiogram (DE-CTPA) can map perfusion at the time of pulmonary embolism diagnosis. Single-photon emission computed tomography ventilation-perfusion scans allow for perfusion tracking similar to DE-CTPA.
Methods |
We present 3 patients with intermediate-risk pulmonary embolism treated with mechanical thrombectomy using the Inari FlowTriever System (Inari Medical, Irvine, Calif). Lung perfusion scoring was applied to pre-procedure and post-procedure imaging. We graded perfusion of each lobe in 3 planes. If the entire lobe was perfused, a score of 3 was assigned. If lung perfusion is normal, total perfusion score is 15. All patients had pre-procedure and follow-up transthoracic echocardiograms.
Results |
All 3 patients were diagnosed with pulmonary embolism via DE-CTPA that showed right ventricle strain and had deep venous thrombosis. Following mechanical thrombectomy, patients immediately experienced improvement in perfusion score; scores continued to improve at follow-up. All patients also had improvement in right ventricle size or function on follow-up echocardiogram.
Discussion |
Intermediate-risk pulmonary embolism often has large initial clot burden that predicts residual pulmonary vascular obstruction. Residual pulmonary vascular obstruction is associated with increased risk of death, recurrent thrombus, and chronic thromboembolic pulmonary hypertension. Clot removal via thrombectomy may decrease the prevalence of residual pulmonary vascular obstruction by improving lung perfusion. We found that mechanical thrombectomy increased lung perfusion immediately and at follow-up assessments.
Le texte complet de cet article est disponible en PDF.Keywords : Computed tomography pulmonary angiogram, Perfusion, Pulmonary embolism, Right heart strain, Thrombectomy, Ventilation-perfusion scan
Abbreviations : DE-CTPA, DOAC, SPECT V/Q, TTE
Plan
| Funding: This manuscript has no relevant disclosures in the form of grants, gifts, or other forms of financial support. |
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| Conflicts of Interest: The authors have no conflicts of interest to disclose. The authors have no relationships with industry. |
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| Authorship: All authors had access to the data and a role in writing the manuscript. SG: Investigation, Data curation, Formal analysis, Writing – original draft, review, & editing; VU: Investigation, Writing – original draft; MK: Resources, Investigation, Methodology; RB: Methodology, Writing – review & editing; VL: Conceptualization, Writing – review & editing; JP: Visualization, Writing – review & editing; GC: Supervision, Writing – review & editing; SD: Resources, Investigation, Methodology, Project administration; PR: Conceptualization, Methodology, Formal analysis, Visualization, Supervision, Project administration, Writing – review & editing. |
Vol 135 - N° 8
P. 1016-1020 - août 2022 Retour au numéro
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