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Delayed mechanical thrombectomy after systemic thrombolysis in massive unilateral pulmonary thromboembolism
  1. Amit Singh Vasan1,
  2. Bharat Hosur2,
  3. Munish Sharma3 and
  4. Yadvir Garg1
  1. 1Pulmonology, Command Hospital Chandimandir, Panchkula, Haryana, India
  2. 2Radiodiagnosis & Interventional Radiology, Command Hospital Chandimandir, Panchkula, India
  3. 3Cardiology, Command Hospital Chandimandir, Panchkula, Haryana, India
  1. Correspondence to Dr Bharat Hosur; hosurbharat{at}gmail.com

Abstract

Pulmonary thromboembolism (PTE) remains the third leading cause of cardiovascular death, after a heart attack and stroke. Haemodynamically unstable PTE (previously called high-risk or massive) is one of the dreaded conditions commonly found in people working in high-altitude areas. Due to the individual variations in clot characteristics and the haemodynamics, these patients offer unique therapeutic challenges by delay in access to tertiary care, being recalcitrant to the systemic thrombolysis as well as complete recanalisation by endovascular thrombectomy. We present a rare case of haemodynamically unstable right pulmonary trunk occlusion with delayed presentation and sustained right ventricular strain despite systemic thrombolysis, managed successfully by catheter-directed thrombectomy. Despite the partial recanalisation of only the right inferior pulmonary artery branches and persistent superior branch occlusion, there was an immediate clinical benefit and no recurrence of symptoms with maintenance therapy of newer oral anticoagulants.

  • Pulmonary embolism
  • Radiology (diagnostics)
  • Interventional radiology

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Footnotes

  • Twitter @VasanAmit, @hosurbharat

  • Contributors ASV received the patient and provided clinical inputs; he also reviewed imaging and prepared part of the manuscript. BH contributed to image acquisition workflow protocols, postprocessing, performing the thrombectomy and manuscript preparation. MS contributed to decision-making, thrombectomy and manuscript review. YG reviewed imaging and provided intellectual contribution to manuscript preparation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.