Massive pulmonary embolism (PE) is a serious and relatively common problem, sometimes very difficult to manage. The conventional treatment (systemic anticoagulation and/or thrombolysis) is associated with significant hemorrhagic and other complications. A new method of therapy is the selective, local, transcatheter infusion of Retavase (Reteplase, recombinant) into the pulmonary arteries.
Twelve patients (24-70 y.o.) with massive bilateral PE, hemodynamically unstable with severe respiratory compromise, were treated with transcatheter directed thrombolysis with Reteplase infusion at 0.5-1 U/hr. Two catheters were simultaneously inserted into one or both common femoral veins and placed in each one of the two pulmonary arteries. The infusion time lasted from 20 to 48 hours.
All patients recovered well. All patients showed significant drops in pulmonary artery systolic pressures ranging from 13-34 mm of Hg. Improvements in pulmonary perfusion with resolution of clot occurred at 24 hours (n 6) and 48 hours (n = 6) of infusion. No significant complications occurred despite the severity of the clinical condition of most patients. Concomitant heparin (400-500 U/hr) was given to some patients.
Bilateral selective pulmonary artery infusion of Retavase is safe, effective and well tolerated for the management of patients with massive PE, especially those who are not candidates for the conventional means of therapy, and those patients being considered for a more aggressive management such as pulmonary embolectomy.
A very serious and potentially lethal condition (massive PE) can be successfully managed with IR methods. Some of these patients would have needed, perhaps, open pulmonary embolectomy, associated with high morbidity and mortality.
Jaime Tisnado, None.