Percutaneous Mechanical Thrombectomy of Submassive Pulmonary Embolism and Extensive Deep Venous Thrombosis for Early Thrombus Removal

Traditional treatment with anticoagulation in nonfatal submassive pulmonary embolism can result in serious sequelae of chronic thromboembolic pulmonary hypertension or poor exercise tolerance, and functional impairment. To prevent long-term complications in previously healthy young patients, other treatment options to actively resolve existing thrombi should be considered. Despite recommendations for use in only severe clinical presentations, endovascular interventional techniques could serve as suitable treatment options for such patients. Here we report the case of a previously healthy 23-year-old female with submassive pulmonary embolism and extensive deep vein thrombosis in the inferior vena cava down to the right popliteal vein. The patient was initially treated with catheterdirected thrombolysis. However, she continued to show extensive venous thrombosis and pulmonary embolism. Percutaneous thrombectomy and aspiration using an AngioJet successfully removed the main pulmonary artery embolism and venous thrombus. The patient’s recovery was uneventful, and 3-month follow-up showed no signs of recurrence or discomfort.

Efficacy and Safety of the Computed Tomography Coronary Angiography Based Approach for Patients with Acute Chest Pain at an Emergency Department: One Month Clinical Follow-up Study

To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.