Aims: Large-bore catheter aspiration embolectomy reduces thrombus burden and right ventricle strain and improves haemodynamics after pulmonary embolism (PE). Sparse data are available for patients with high-risk PE and contraindications to thrombolysis or thrombolysis failure, particularly if veno-arterial extracorporal membrane oxygenation (VA-ECMO) is required.
Methods And Results: All patients with acute high-risk PE and contraindications to thrombolysis undergoing FlowTriever® percutaneous embolectomy and VA-ECMO circulatory support (or standby) at the University Hospital Zurich between April 2021 and August 2022 were retrospectively analysed. The primary outcome was the combination of recurrent PE, heart failure hospitalization, and all-cause death at 30 days. The analysis included 15 patients: mean age was 63.1 years and 14 (93%) were men. Overall, four (27%) patients presented with cardiac arrest, eight (53%) with ongoing obstructive shock, and three (20%) with persistent arterial hypotension. Veno-arterial extracorporal membrane oxygenation was implanted prior to aspiration embolectomy in eight (53%) patients. Three of seven patients without initial VA-ECMO support experienced periprocedural cardiac arrest, of whom two received ECMO support before completion of embolectomy. Veno-arterial extracorporal membrane oxygenation weaning was successful in all patients after a mean of 5.4 days. There was one periprocedural death in a patient who did not receive VA-ECMO support following a periprocedural cardiac arrest. The primary outcome at 30 days occurred in five (33.3%; 95% confidence interval 13.0-61.3%) patients.
Conclusion: This study provides preliminary evidence for the feasibility of percutaneous large-bore aspiration embolectomy in combination with VA-ECMO support (or standby) in patients with high-risk PE and contraindications to thrombolysis.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1093/ehjacc/zuad014 | DOI Listing |
Can J Neurol Sci
November 2024
Department of Surgery, University of Alberta, Edmonton, AB, Canada.
This review looks back on our experience with acute middle cerebral artery embolectomies in the 1990s, frowned upon by stroke experts at the time, and no match for the newly introduced and proven treatment of acute ischemic stroke with intravenous recombinant tissue plasminogen activator (alteplase). The past several decades have seen dramatic developments in acute cerebral revascularization, the major paradigm shift being in the form of endovascular thrombectomy. Mechanical thrombectomy has moved from the operating room, where we performed it, to the interventional angiography suite armed with ever-improving clot aspiration and retrieval technologies.
View Article and Find Full Text PDFLaryngoscope
September 2024
Department of Pediatric Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio, U.S.A.
Objectives: To describe operative techniques using rigid bronchoscopy and ferromagnetic bronchoscopic equipment to retrieve magnetic foreign bodies in distal tertiary bronchi beyond the reach of traditional optical instrumentation.
Methods: A 13-year-old presented to the Emergency Department following aspiration of three backing magnets from a magnetic nose ring. Chest radiographs demonstrated a 4 mm × 3 mm foreign body in the right lower lobe 0.
Ther Adv Cardiovasc Dis
September 2024
Department of Cardiology and Vascular Medicine, GRN Hospital Weinheim, Roentgenstrasse 1, Weinheim D-69469, Germany.
Acute limb ischemia (ALI) due to arterial thromboembolic occlusion is a critical emergency in vascular medicine, requiring attention for rapid diagnosis and intervention, to prevent limb loss and major amputation, which is associated with patient disability in the long term. Traditionally, surgical embolectomy has been used for the treatment of ALI. Endovascular treatment of ALI traditionally involved catheter-directed thrombolysis.
View Article and Find Full Text PDFClin Appl Thromb Hemost
August 2024
Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA.
Objectives: To construct a new scoring system utilizing biomarkers, vitals, and imaging data to predict 30-day mortality in acute pulmonary embolism (PE).
Background: Acute PE, a well-known manifestation of venous thromboembolic disease, is responsible for over 100,000 deaths worldwide yearly. Contemporary management algorithms rely on a multidisciplinary approach to care via PE response teams (PERT) in the identification of low, intermediate, and high-risk patients.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!