In Reply to: Re: Case 1097_05 -- Pulmonary embolism with selective thrombolysis posted by Luke Sewall on October 16, 1997 at 18:02:19:
Very nice result. I wonder, however, whether systemic lysis (either endogenous or exogenous) would have achieved the same result. The old (1960s) literature is replete with studies of unassisted spontaneous lysis of PE.
Devices: we have done one case with the Amplatz device in a patient who was hypotensive and in extremis; though the angio did not change all that much, the patient recovered dramatically on the table after treatment. I hypothesize we drilled a lot of holes in the clot. Perhaps I will post the case in a future month. I know of one case from the Czech republic in which a long Arrow PTD (available in 100 cm in Europe) was used with similar dramatic results. A larger, longer, over the wire version of the PTD is being developed for this application and DVT. I have heard mixed reviews from others about devices in this application: the clot is old so many of the "vortex" devices will not work at all. There is a lot of room for research here!