In Reply to: Re: Case 1001-07 -- Pulmonary Artery Thrombectomy and Thrombolysis posted by Dan Sze on October 08, 2001 at 20:48:48:
The result is very good. I am convinced that aggressive endovascular management of massive pulmonary embolism is justified, especially in very symptomatic patients just as the one you present. I have had amazing responses in critically ill patients after mechanical thrombectomy using the Amplatz thrombectomy device. I agree with Dan, these devices are imperfect, mainly because they leave residual thrombus and the patient is at risk of developing pulmonary hypertension if he (she) survives the acute insult. I agree, if the patient is not at an extremely high risk, the way to go is catheter directed thrombolysis. In my opinion, this form of treatment offers the best chance of dissolving most of the clot burden and potentially avoid late pulmonary hypertension.
I think your bolus dose of tPA was a little high. I probably would have used 5 mg in a pulse spray fashion. For the long-term infusion, I would probably use 0.5 - 1.0 mg/hr. The cases that we did with urokinase we ran them at a low dose (60,000 - 120,000 units per hour and the results were very good).
Very nice result.