• Laurencia Villalba, Tam Nguyen, Rui L Feitosa, Prashanth Gunanayagam, Naomi Anning, and Kate Dwight.
• Department of Vascular Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia; Vascular Care Centre, Wollongong, New South Wales, Australia; University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales, Australia. Electronic address: laurenciavillalba@live.com.
• J. Vasc. Surg. 2019 Dec 1; 70 (6): 1920-1926.

ObjectiveAn alternative single-session catheter-directed thrombolysis (CDT) method using adjunctive power-pulse spray (PPS) technique (with the AngioJet system; Boston Scientific, Fremont, Calif) was investigated to evaluate its safety and effectiveness in the treatment of acute massive and submassive high-risk pulmonary embolism (PE).MethodsBetween May 2016 and July 2018, patients diagnosed with extensive massive or submassive PE who triggered intensive care unit involvement and were considered for escalation of treatment were offered CDT with adjunctive PPS technique, provided they met the clinical inclusion criteria. Clinical success was defined as stabilization of hemodynamic parameters, resolution of hypoxia, and survival to discharge. In addition, reversal of right ventricular (RV) failure and pulmonary artery hypertension was evaluated after 24 to 48 hours using echocardiography. After 4 weeks, echocardiography was repeated to check for reversal of RV failure and pulmonary artery hypertension. In addition, computed tomography pulmonary angiography was performed to check for residual thrombus. Functional capacity was also re-evaluated at the follow-up consultation.ResultsDuring the study period, 575 inpatients were diagnosed with PE at The Wollongong Hospital. Of these patients, 32 (5.6%) were referred for escalation of treatment, met the inclusion criteria, and received treatment with the CDT and PPS technique. These patients were classified as having massive (23 [71.9%]) or submassive (9 [28.1%]) PE. Technical success was achieved in all 32 patients, and 31 patients survived to discharge (96.9%). There were no major or minor adverse events and no procedure-related complications. Improvement of RV strain and pulmonary hypertension was achieved in all survivors within 48 hours of the intervention. Furthermore, all echocardiograms completed at 4 weeks after discharge were reported normal. Results from computed tomography pulmonary angiography 4 weeks after discharge demonstrated complete resolution of thrombus in 79.3% of patients, and the remaining 20.7% had only minor residual thrombus reported. In addition, 82.8% of patients reported a return to premorbid exercise tolerance by the time of postoperative consultation with the treating physician (mean follow-up, 6.7 weeks).ConclusionsThis initial series indicates that single-session CDT with adjunctive PPS technique using the AngioJet system is safe and effective in treating massive and submassive acute PE. It appears to offer several potential advantages compared with current options, allowing safer and faster thrombus resolution. Multicenter prospective trials are required to validate these findings.Copyright © 2019 Society for Vascular Surgery. All rights reserved.

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