Background: Pulmonary embolism (PE) is a common disease with an annual incidence of
about 1/1000 persons. About every sixth patient dies within the first 30 days after
diagnosis. The electrocardiogram (ECG) is one of the first diagnostic tests performed,
and is able to confirm the suspicion of PE with typical electrocardiographic signs.
Some ECG signs and their regression are also prognostically relevant. Endovascular
mechanical thrombectomy is one option for PE treatment, and aims to relieve right
heart strain immediately. The first studies on endovascular mechanical thrombectomy
using a dedicated device (FlowTriever System, Inari Medical, Irvine, CA, USA) yielded
promising results. Methods: In the following, we report the case of a 66-year-old
male patient who presented with New York Heart Association III dyspnea in our emergency
department. Among typical clinical and laboratory results, he displayed very impressive
electrocardiographic and radiological findings at the time of PE diagnosis. Results:
After endovascular mechanical thrombectomy, the patient's complaints and pulmonary
hemodynamics improved remarkably. In contrast, the ECG worsened paradoxically 18 h
after intervention. Nevertheless, control echocardiography 4 days after the intervention
no longer showed any signs of right heart strain, and dyspnea had disappeared completely.
At a 4-month follow-up visit, the patient presented as completely symptom-free with
a high quality of life. His ECG and echocardiography were normal and excluded recurrent
right heart strain. Conclusions: Overall, the patient benefitted remarkably from endovascular
mechanical thrombectomy, resulting in an almost complete resolution of electrocardiographic
PE signs at the 4-month follow-up after exhibiting multiple typical electrocardiographic
PE signs at time of diagnosis and initial electrocardiographic worsening 18 h post
successful intervention.
