Interventional procedure overview of percutaneous thrombectomy for massive pulmonary embolism

Indications and current treatment

A pulmonary embolism (PE) is an obstruction of a pulmonary artery usually caused by an embolus that travels to the lungs from deep veins in the leg or pelvis. Pulmonary embolism often causes shortness of breath, chest pain and cough. The symptoms and severity vary from no symptoms to cardiovascular collapse and death. A massive PE is defined by sustained systemic hypotension or shock (high-risk PE). A sub-massive PE involves right ventricular dysfunction or myocardial injury but without haemodynamic compromise (intermediate-risk PE).

Massive PE accounts for less than 10% of acute PE cases and is a medical emergency with a high mortality rate. The first-line treatment for PE is systemic anticoagulants. In cases of massive or sub-massive PE, systemic thrombolysis may be used, and rarely open surgical embolectomy is performed. Catheter-directed therapies may be used which include catheter-directed thrombolysis (CDT) and percutaneous thrombectomy. Percutaneous thrombectomy is usually used for patients who have suffered a massive PE and in whom thrombolysis is contraindicated or has failed and who are not candidates for surgery.