Fig. 2.2–5a, b Dispersion of small thrombi into the peripheral branches of the pulmonary artery after mechanical fragmentation.
Mechanical and rheolytic catheter thrombectomy
No mechanical thrombectomy systems are currently approved for use in patients with major pulmonary embolism. Ideally, the system should be very flexible, allowing easy passage into the right heart and pulmonary artery system with high suction, with no risk of damaging the pulmonary arteries.
Various systems that are used on an off-label basis at the moment, such as the AngioJet™ (Possis, Fig. 2.2-6), Amplatz Clot Buster™ (BARD), and Hydrolyser™ (J&J Cordis), were not designed for use in vessels with large lumina and therefore have to be used in combination with local fibrinolytic therapy.
Potential side effects of these catheter systems include mechanical hemolysis, macroembolization, and microembolization. According to the current literature, only 5% of patients with a major pulmonary embolism are treated with a mechanical catheter thrombectomy system. Thrombectomy catheters that have been used to date are:
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