Soledad Loyola

Mechanical Fragmentation and Pharmacologic Thrombolysis in Massive Pulmonary Embolism

PURPOSE To evaluate the usefulness of mechanical fragmentation associated with intrapulmonary thrombolysis in acute massive pulmonary embolism (PE). PATIENTS AND METHODS Sixteen cases of massive PE treated with mechanical fragmentation associated with pharmacologic thrombolysis were retrospectively studied. Severity of PE was assessed with the angiographic index according to the Urokinase Pulmonary Embolism Trial (maximum value of 18; score according to whether obstruction was central or peripheral, complete or partial). Mechanical fragmentation of the emboli was performed with angiographic catheters and angioplasty balloons. Urokinase was infused directly into the thrombus during the course of 8-24 hours. The effect of therapy was measured with direct pulmonary artery pressure (PAP) and blood O2 values. RESULTS Pre- and postinfusion angiographic index mean values (+/- standard deviation) were 13.7 +/- 1.4 and 6.1 +/- 2.2 (P < .0001). Mean pre- and postinfusion PAPs were 48.2 +/- 13.4 and 18.5 +/- 7.2 mm Hg (P < .0001). PaO2 increased from 60.1 +/- 12.1 to 88.7 +/- 23.4 mm Hg (P = .01). Fourteen patients (87.5%) completely recovered. One patient died during treatment despite improvement in PAP and PaO2 parameters. There were no major hemorrhagic complications. CONCLUSIONS The data support the efficacy of mechanical fragmentation associated with pharmacologic thrombolysis in the treatment of acute massive PE, resulting in improved hemodynamics and-blood oxygenation and in decreased PAP, with low morbidity.

Massive Pulmonary Embolism: Treatment with the Hydrolyser Thrombectomy Catheter

PURPOSE To assess the efficacy of clot removal with use of the Hydrolyser thrombectomy catheter in acute massive pulmonary embolism (PE). MATERIALS AND METHODS Eleven patients (eight women, three men) with a mean age of 61 (range, 37-79) years with acute massive PE underwent percutaneous mechanical thrombectomy (PMT) with use of the Hydrolyser. In four patients with no contraindication, fibrinolysis was performed with use of urokinase at low doses after thrombectomy. RESULTS Ten patients (90.91%) recovered from massive PE and were discharged within 11 days. The Urokinase Pulmonary Embolism Trial angiographic severity indexes (mean +/- SD) were 14.7 +/- 2.6 and 7.5 +/- 2.7, respectively, before and after thrombectomy (P < .001). Partial arterial pressures of O2 increased from 72.8 mm Hg +/- 16.4 to 93.5 mm Hg +/- 5.6 (P < .005). Pulmonary artery pressure decreased from 45.5 mm Hg +/- 14.2 to 29.5 mm Hg +/- 13.6 after thrombectomy (P < .0001). Calculated by semiquantitative computed analysis, PMT with use of the Hydrolyser removed 74.06% of thrombus +/- 13.46%. One patient developed self-limited hemoptysis immediately after thrombectomy. One patient died during the procedure secondary to PE. CONCLUSION PMT with use of the Hydrolyser is effective and safe in massive PE, resulting in improved hemodynamics and blood oxygenation and decreased pulmonary artery pressure. It offers an alternative to fibrinolysis and surgical thrombectomy.

Massive pulmonary embolism: percutaneous mechanical thrombectomy during cardiopulmonary resuscitation.

Seven patients with massive pulmonary embolism (PE) causing cardiac arrest underwent percutaneous mechanical thrombectomy (PMT) with Hydrolyser and Oasis catheters during cardiopulmonary resuscitation (CPR). Three received adjunctive recombinant tissue plasminogen activator. Thrombectomy was successful in restoring pulmonary perfusion in six patients (85.7%). One patient died of cardiac arrest. Systolic pulmonary pressure decreased after thrombectomy from a median of 73 mm Hg (range, 63-90 mm Hg) to 42 mm Hg (range, 32-81 mm Hg; P < .05). There was one groin hematoma that required blood transfusion. In conclusion, massive PE causing cardiac arrest can be treated with PMT simultaneously with CPR maneuvers to rapidly revert circulatory collapse, with restoration of pulmonary circulation. Larger series are needed to validate this method.

Carotid artery dissection: endovascular treatment. Report of 12 patients.

The purpose of this article is to report our experience with endovascular treatment of internal carotid artery (ICA) dissection with the use of stents.

TIPSS Procedure in the Treatment of a Single Patient After Recent Heart Transplantation Because of Refractory Ascites Due to Cardiac Cirrhosis

We present the case of a female patient with arrhythmogenic dysplasia of the right ventricle who evolved to refractory heart failure, ascites, and peripheral edema. As a result, heart transplantation was performed. Subsequently, refractory ascites impaired the patient’s respiratory function, resulting in prolonged mechanical ventilation. She was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement, which allowed satisfactory weaning of ventilatory support.

Quimioembolización hepática en el manejo terapéutico del hepatocarcinoma. Reporte de dos casos

Chemoembolization is a therapeutic alternative for those patients with hepatocarcinoma that cannot be excised surgically or that are waiting a liver allograft. We report two patients with hepatocarcinoma who were subjected to chemoembolization. A 65 years old male with a chronic liver disease and right lobe hepatocarcinoma, waiting for a liver transplantation, was subjected to two sessions, of chemoembolization four weeks apart. A magnetic resonance showed a 80% reduction of tumor volume one month later. A 72 years old diabetic male with an alcoholic liver disease with two hepatocarcinoma in the right lobe was subjected to two sessions of chemoembolization, separated by four weeks. A magnetic resonance one month later showed the absence of blood flow in both lesions, suggesting complete necrosis.