Interventional radiology treatment for pulmonary embolism

Table 1 Predictive factors of severity and 30-d mortality

Predictors of 30-d mortality
Cardiac failure
COPD
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

Modified from Pizza et al[16]. COPD: Chronic obstructive pulmonary disease; bpm: Beat per minute; ECG: Electrocardiogram; BNP: Brain-type natriuretic peptide; H-FABP: Heart-type fatty acid-binding protein; RV: Right ventricle; CT: Computed tomography.

Table 2 Fibrinolytic treatments used in massive pulmonary embolism

Fibrinolytic agent	Infusion treatment 12-24 h	Short infusion treatment
Urokinase	4400 IU/kg (bolus/30 min) + 4400 IU/kg per hour 12-24 h	3 million IU/2 h
Streptokinase	250000 IU (bolus/15 min) + 100000 IU/h 12-24 h	1.5 million IU/2 h
r-tPA	N/A	100 mg/2 h

N/A: Not applicable.

Table 3 Fragmentation and aspiration devices used in the endovascular treatment of pulmonary embolism

Endovascular mechanisms of thrombectomy and thrombolysis	Rheolytic	Rotational	Aspiration	Fragmentation	Ultrasound
Devices	Angio Jet	Rotarex	Indigo	Fogarty arterial balloon embolectomy catheter	Ekos Sonic
	Boston Scientific	Aspirex	Penumbra	Edwards	BTG
		Straub Medical
	Hydrolyzer			Pig-tail Catheter
	Cordis			Cook Medical
Mechanism	Pressurized saline or fibrinolytic agent injection through the catheter in the distal tip, and the remaining fragmented thrombus is aspirated	High-speed rotation coil within the catheter, creating a negative pressure and aspiration of the thrombus	Aspiration pump that provides a high negative pressure of suction with a guide-wire (separator) to create fragmentation of the thrombus	Performing balloon sweeps or manually rotation of the standard Pig-tail to fragment the thrombus	Ultrasound emitting catheter localized within the thrombus to generate an acoustic field creating a more lytic dispersion of the drug infused

Modified from Barjaktarevic et al[39].