Q; What are the 3 catheter based interventions to perform mechanical thrombectomy in massive/submassive pulmonary embolism?


Answer: 

Broadly there are 3 categories of percutaneous catheter intervention in pulmonary emboli:

1. Aspiration thrombectomy,
2. Thrombus fragmentation,
3. Rheolytic thrombectomy*

Mechanical thrombectomy should be avoided beyond the main and lobar pulmonary arterial branches. Direct intra-arterial delivery of thrombolytics, may be helpful if mechanical thrombectomy is ineffective.

*Rheolytic thrombectomy catheters use a high-velocity saline jet to fragment adjacent thrombus by creating a Venturi effect.

References:

Fava M, Loyola S. Applications of percutaneous mechanical thrombectomy in pulmonary embolism. Tech Vasc Interv Radiol. 2003; 6: 53–58.

Cho KJ, Dasika NL. Catheter technique for pulmonary embolectomy or thrombofragmentation. Semin Vasc Surg. 2000; 13: 221–235.

Kucher N, Windecker S, Banz Y, Schmitz-Rode T, Mettler D, Meier B, Hess OM. Percutaneous catheter thrombectomy device for acute pulmonary embolism: in vitro and in vivo testing. Radiology. 2005; 236: 852–858