Catheter directed thrombolysis (CDT) and thrombectomy represent well established techniques
for the treatment of intermediate pulmonary embolism (IPE). The long-term effect of
catheter directed thrombolysis of IPE is unknown.Clinical, interventional and echocardiographic
data from 80 consecutive patients with IPE who were treated with CDT were evaluated.
Primary end-points were technical success and major adverse events (MAEs). Secondary
end-points were cardiovascular mortality, all-cause mortality, clinical success, rate
of bleeding complications, improvement in pulmonary pressure and echocardiography
parameters. CDT completed with alteplase (10 mg bolus and 1 mg/h maintenance dose)
through a pig-tail catheter for 24 h. After 24 h, control pulmonary angiography was
performed.In total, 80 patients with a mean age of 59.0 ± 16.8 years were treated.
CDT was successful after the first post-operative day in 72 (90%) patients, but thrombus
aspiration and fragmentation was performed due to failed thrombolysis in 8 (10%) patients.
Final technical and clinical success was reached in 79 (98.8%) and 77 (96.3%) patients,
respectively. The mean CDT time in IPE was 27.8 ± 9.6 h. Invasive pulmonary pressure
dropped from 57.5 ± 16.7 to 38.9 ± 13.5 (p < 0.001). A caval filter was implanted
in 4 (5%) patients. The 1-year MAE and cardiovascular mortality rate was 4.0% and
1.4%, respectively. Access site complications (6 major and 6 minor) were encountered
in 12 (16.2%) patients.Catheter directed thrombolysis in submassive pulmonary embolism
had excellent results. However, additional mechanical thrombectomy was necessary in
some patients to achieve good clinical outcomes.
