Traditional therapy for pulmonary embolism includes systemic anticoagulation, systemic thrombolysis, catheter-directed thrombolysis / suction catheter thrombectomy, and surgical thromboembolectomy. Currently, the standard treatment for submassive and massive pulmonary embolism involves the use of systemic anticoagulation. However, unlike systemic anticoagulation there is no standard treatment algorithm for the use of thrombolytics to aggressively treat pulmonary embolism and its sequelae. This case report discusses the successful use of thrombolytics using the EKOS EkoSonic Ultrasound-Accelerated Thrombolysis System in the treatment of bilateral submassive pulmonary emboli along with a saddle pulmonary embolus. The EKOS ultrasound-accelerated thrombolysis procedure resulted in rapid substantial clinical improvement, resolution of bilateral pulmonary emboli along with resolution of the saddle pulmonary embolus, restoration of pulmonary blood flow with resolution of pulmonary hypertension, and normalization of pulmonary embolism-related cardiac dysfunction. This novel application of ultrasound-accelerated thrombolytic infusion directly into the pulmonary arteries for pulmonary embolism provides a potential new treatment option and a valuable addition to the treatment algorithm for the management of both submassive and massive pulmonary embolism.
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