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Editorials |

Percutaneous Mechanical Thrombectomy for Acute Pulmonary Embolism : A Double-Edged Sword

Samuel Z. Goldhaber, MD, FCCP
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Boston, MA

Correspondence to: Samuel Z. Goldhaber, MD, FCCP, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115-6110; e-mail: sgoldhaber@partners.org



Chest. 2007;132(2):363-365. doi:10.1378/chest.07-0591
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Major pulmonary embolism (PE) can cause death from right-heart failure1 and, among survivors, may lead to disabling chronic thromboembolic PE.2 Massive PE is rare but often obvious when it occurs during hospitalization. There is dramatic sudden onset of hypotension, tachycardia, and respiratory distress, often accompanied by new right bundle-branch block on the ECG. This medical emergency can be catastrophic and usually requires emergency thrombolysis or embolectomy in addition to intensive anticoagulation, vasopressors, and mechanical ventilation.3 In contrast, submassive PE is more common, but its presentation is often subtle and insidious. Initially, patients usually appear clinically stable. They always have preserved systemic arterial pressure, and at times even the heart rate and respiratory rate may be normal. Optimal management of submassive PE requires rapid and accurate risk stratification based on clinical assessment, cardiac biomarkers, and determination of right ventricular size and function.4 The most validated risk-assessment tool is echocardiography. Right ventricular hypokinesis on echocardiography predicts a doubling of mortality within the next 30 days, even among initially normotensive patients.5 Right ventricular enlargement on chest CT also portends a greater likelihood of death or major in-hospital complication.6

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