AngioJet® rheolytic thrombectomy: a new treatment option in cases of massive pulmonary embolism

Background: Pulmonary embolism (PE) with hemodynamic instability is associated with high mortality. While thrombolysis remains the treatment of choice for massive PE, percutaneous mechanical thrombectomy may be an alternative in selected cases. Methods & results: We performed a systematic review of the literature for articles dealing with the use of the AngioJet® (Medrad/Bayer Interventional, MN, USA) device (i.e., rheolytic thrombectomy) in the setting of massive/submassive PE. We identified 14 studies with a total of 197 patients: nine studies including 76 patients presenting exclusively with massive PE (group A, mean age: 59.2 ± 9.7 years), and five studies including 121 patients presenting with massive or submassive PE (group B, mean age: 61.8 ± 5.4 years). The success rate of the procedure, defined as technical ± clinical success, was reported as 86.8% in group A and as 94.3% in group B. Postprocedural thrombolysis was administered in 17.8 and 25.4% of cases, respectively. Periprocedural events (e.g., cardiovascular complications or other unexpected adverse events) were observed in 21.1% in group A, and 17.4% in group B. In-hospital mortality was 23.7 and 13.2%, respectively. Device-related major and minor complications were observed in 15.7% of cases. Conclusion: The AngioJet seems to be a safe and efficacious thrombectomy device in term of thrombus fragmentation/aspiration, as well as improvement of clinical parameters. However, mortality rate in these unstable settings remain high, and more data are needed before broadening the use of percutaneous mechanical thrombectomy in PE patients.