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Endovascular thrombectomy using a stent retriever catheter for massive pulmonary thromboembolism - 18/10/22

Doi : 10.1016/j.ajem.2022.08.007 
Saaya Ichiyama, MD a, b, Takaaki Maruhashi, MD, PhD a, , Ryoichi Kitamura, MD a, Yutaro Kurihara, MD a, Daisuke Kinoshita, MD, PhD c, Nobuhiro Sato, MD, PhD c, Naruya Ishizue, MD, PhD c, Yuki Ikeda, MD, PhD c, Yasushi Asari, MD, PhD a
a Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 
b Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Aomori, Japan 
c Department of Cardiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan 

Corresponding author at: Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan.Department of Emergency and Critical Care MedicineKitasato University School of Medicine1-15-1 KitasatoMinami-kuSagamiharaKanagawa252-0375Japan

Abstract

Acute massive pulmonary thromboembolism (PE) has a high mortality rate of 18%–65%. Along with anticoagulation and thrombolytic therapy, treatment may require a catheter-based thrombectomy or surgical thrombectomy. We report a case of pulmonary thromboembolism treated with a Stent Retriever (Trevo® NXT ProVue Retriever, Stryker, Kalamazoo, MI, USA), which is commonly used to treat stroke. An 81-year-old woman complained of back pain and was transported to our hospital after she became unconscious. Cardiopulmonary resuscitation was initiated before her arrival at the hospital; she returned to spontaneous circulation after arrival. After undergoing computed tomography (CT) scanning, she went into cardiac arrest again, and we established veno-arterial extracorporeal membrane oxygenation and performed catheter thrombectomy using a stent retriever. The left basilar pulmonary artery and the right middle pulmonary artery trunk were retrieved after the stent's deployment, and bilateral pulmonary arteries were confirmed to be reopened. A residual thrombus was present, and Monteplase was administered. A contrast-enhanced CT scan taken on day 15 following admission revealed that the thrombus had disappeared, and echocardiography revealed improved right ventricular dysfunction. The patient was transferred to another hospital on day 64 for rehabilitation. We report the first case of pulmonary artery thrombosis that was successfully recanalized by endovascular treatment with a stent retriever. The stent retriever may be useful as an endovascular treatment device for PE because it is easier to achieve recanalization using this method compared to conventional treatment methods.

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Highlights

This is first report with endovascular thrombectomy using a stent retriever catheter for massive pulmonary thromboembolism.
Currently, a minimally invasive method of thrombectomy without residual thrombus for pulmonary embolism has not been established.
The stent retriever is a catheter used to thrombectomy for acute cerebral infarction, and is capable of removing thrombi without residual thrombus or distal embolization.
We speculated that stent retrievers may be also useful as a new treatment device for massive pulmonary thromboembolism.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Endovascular thrombectomy, Massive pulmonary thromboembolism, Stent retriever catheter, Extracorporeal membrane oxygenation

Abbreviations : PE, CT


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© 2022  The Authors. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
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Vol 61

P. 233.e3-233.e6 - novembre 2022 Ritorno al numero
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