Rheolytic thrombectomy for pulmonary embolism

Rheolytic thrombectomy for pulmonary embolism

Rheolytic thrombectomy can be considered when there is contraindication to systemic thrombolysis in patients with pulmonary embolism and right ventricular dysfunction [Ferrigno L et al. Management of pulmonary embolism with rheolytic thrombectomy. Can Respir J. 2011;18:e52-8]. It is combined with local thrombolysis delivered through the catheter directly into the occluded pulmonary artery. The device used for rheolytic thrombectomy is the Angiojet catheter which is a dual lumen 100 cm catheter which fragments and aspirates thrombi using the Bernoulli principle. It is introduced through a long sheath which is introduced through the femoral vein into the pulmonary artery. One lumen of the Angiojet catheter carries high velocity high pressure saline jet that is aspirated back through the other lumen. The resulting low pressure vortex macerates and aspirates the thrombus back through the return lumen.

The same system has been used in other arteries like the coronary artery and even for cerebral venous thrombosis [Zhang A et al. Rheolytic thrombectomy for cerebral sinus thrombosis. Neurocrit Care. 2008;9:17-26]. The injectate contains recombinant tissue type plasminogen activator (r-tPA), most of which is aspirated back by the return lumen. Local thrombolysis can be achieved by injecting thrombolytics using the power-pulse-spray mode of this device as well.