Difference between revisions of "Pulmonary Embolism Mechanical Thrombectomy"

Line 15: Line 15:
 
* Pulmonary arteriogram, measure pulmonary arterial pressures, make decision for thrombectomy
 
* Pulmonary arteriogram, measure pulmonary arterial pressures, make decision for thrombectomy
 
* 22 Fr Dryseal sheath exchange over Amplatz guidewire
 
* 22 Fr Dryseal sheath exchange over Amplatz guidewire
* Cross the pulmonary embolism with the 1cm floppy tipped Amplatz guidewire
+
* Cross the pulmonary embolism with the 1cm floppy tipped Amplatz guidewire. A Vert catheter may help for selection.
 
* Engage aspiration catheter onto the clot, begin aspiration
 
* Engage aspiration catheter onto the clot, begin aspiration
 
* If no blood return, remove the aspiration catheter with suction engaged and flush with saline
 
* If no blood return, remove the aspiration catheter with suction engaged and flush with saline

Revision as of 07:31, 19 February 2019

Pre-thrombectomy pulmonary arteriogram - (47/26 mmHg, mean 33 mmHg)

Inari Medical

  • Standard venous access equipment
  • 22 Fr Gore Dryseal sheath
  • 260cm Amplatz Super Stiff with a 1 cm floppy tip
  • Angled pigtail catheter
  • Bentson guidewire
  • Inari 20 Fr 95 cm aspiration catheter
  • Inari flowtriever device (optional)

Steps:

  • Femoral vein access
  • Pulmonary artery access using angled pigtail catheter, using a curved back end of the Bentson for stiffness and directionality may help
  • Pulmonary arteriogram, measure pulmonary arterial pressures, make decision for thrombectomy
  • 22 Fr Dryseal sheath exchange over Amplatz guidewire
  • Cross the pulmonary embolism with the 1cm floppy tipped Amplatz guidewire. A Vert catheter may help for selection.
  • Engage aspiration catheter onto the clot, begin aspiration
  • If no blood return, remove the aspiration catheter with suction engaged and flush with saline
  • Repeat as necessary
Post-thrombectomy pulmonary arteriogram - (26/20 mmHg, mean 22 mmHg)
Aspirated clot burden

Contributing Authors

Kevin Liu