Angioscopy-guided selective aspiration thrombectomy for acute pulmonary thromboembolism.

Komatsu S, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220059 An 83-year-old woman with a history of pulmonary thromboembolism 10 years ago was referred for dyspnea. Anticoagulation therapy was terminated by her family doctor 3 years previously. On admission, D-dimer level was 16.6 μg/mL and arterial blood gas showed 88.1% on room air. Pulmonary arteriography (PAG) revealed some filling defects, mainly in the right interlobar artery (figure 1A). Non-obstructive angioscopy (NOA) showed two kinds of thrombi in the pulmonary arteries. At the translucent area, a massive, red, smooth thrombus was seen (figure 1B, video 1). Between the massive thrombus, floating, mobile, white-red, puff-like thrombi were demonstrated (figure 1C, video 2). As the thrombi entered the catheter spontaneously, aspiration was performed using a 20 mL syringe. Thrombi in the guiding catheter were collected by removing the guiding catheter. For the first trial, red thrombi were effectively aspirated (figure 1D). Puff-like thrombi in the truncus anterior, interlobar artery and basal trunk were aspirated while monitoring via NOA with a total of three trials, and arterial blood gas rapidly improved by 97.9% on room air. PAG showed diminished deficit, and additional anticoagulation therapy was continued for 3 weeks.