Copyright ©The Author(s) 2017.
World J Radiol. Jul 28, 2017; 9(7): 295-303
Published online Jul 28, 2017. doi: 10.4329/wjr.v9.i7.295
Table 1 Predictive factors of severity and 30-d mortality
Predictors of 30-d mortality
Cardiac failure
Systolic pressure < 100 mmHg
Age over 70 yr
Heart rate > 100 bpm
ECG signs of RV dysfunction
Elevated cardiac biomarkers (Troponins, BNP, H-FABP)
CT findings: RV enlargement
Echocardiography findings:
RV hypokinesis and dilatation
Deviation of the interventricular septum
Tricuspid regurgitation > 2.6 m/s
Loss of inspiratory collapse of the inferior vena cava
Patent foramen ovale
Table 2 Fibrinolytic treatments used in massive pulmonary embolism
Fibrinolytic agentInfusion treatment 12-24 hShort infusion treatment
Urokinase4400 IU/kg (bolus/30 min) + 4400 IU/kg per hour 12-24 h3 million IU/2 h
Streptokinase250000 IU (bolus/15 min) + 100000 IU/h 12-24 h1.5 million IU/2 h
r-tPAN/A100 mg/2 h
Table 3 Fragmentation and aspiration devices used in the endovascular treatment of pulmonary embolism
Endovascular mechanisms of thrombectomy and thrombolysisRheolyticRotationalAspirationFragmentationUltrasound
DevicesAngio JetRotarexIndigoFogarty arterial balloon embolectomy catheterEkos Sonic
Boston ScientificAspirexPenumbraEdwardsBTG
Straub Medical
HydrolyzerPig-tail Catheter
CordisCook Medical
MechanismPressurized saline or fibrinolytic agent injection through the catheter in the distal tip, and the remaining fragmented thrombus is aspiratedHigh-speed rotation coil within the catheter, creating a negative pressure and aspiration of the thrombusAspiration pump that provides a high negative pressure of suction with a guide-wire (separator) to create fragmentation of the thrombusPerforming balloon sweeps or manually rotation of the standard Pig-tail to fragment the thrombusUltrasound emitting catheter localized within the thrombus to generate an acoustic field creating a more lytic dispersion of the drug infused