Catheter-directed thrombolysis guided by pulmonary artery pressure registration in pulmonary embolism: a case report

Ehssan Berenjkoub; Charlotte Kemper; Nicole Lewandowski; Marc Horlitz; Dennis Rottländer

doi:10.1093/ehjcr/ytae015

Catheter-directed thrombolysis guided by pulmonary artery pressure registration in pulmonary embolism: a case report

Eur Heart J Case Rep. 2024 Jan 6;8(1):ytae015. doi: 10.1093/ehjcr/ytae015. eCollection 2024 Jan.

Authors

Ehssan Berenjkoub¹, Charlotte Kemper¹, Nicole Lewandowski¹, Marc Horlitz^{1

2}, Dennis Rottländer^{1

2}

Affiliations

¹ Department of Cardiology, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149 Cologne, Germany.
² Department of Cardiology, University Witten/Herdecke, Faculty of Health, School of Medicine, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany.

Abstract

Background: Duration and dosage of thrombolysis for ultrasound-assisted catheter-directed thrombolysis (UACDT) in patients with intermediate high-risk pulmonary embolism remain controversial and treatment protocols vary.

Case summary: A 58-year-old female patient suffered from a right-sided urolithiasis. The clinical course was complicated by an intermediate high-risk pulmonary embolism [pulmonary embolism severity index (PESI) score 108 points and simplified PESI ≥1] with bilateral proximal thrombus and significant right heart dysfunction. The pulmonary embolism response team (PERT) made a decision towards UACDT. The standard duration of UACDT ranges between 6 and 15 h depending on clinical parameters. In this particular case, the clinical parameters such as heart rate (no tachycardia) or oxygen saturation (chronic obstructive pulmonary disease) might lead to premature termination of UACDT. Therefore, PERT decided to additionally monitor pulmonary artery pressure (PAP) continuously during the UACDT via a separate pigtail catheter in the pulmonary artery. Ultrasound-assisted catheter-directed thrombolysis was performed using 1 mg/h recombinant tissue plasminogen activator (rtPA) per catheter, while PAP was registered continuously. Heart rate and oxygen saturation remained unchanged during UACDT. However, after 6 h of UACDT, systolic PAP decreased slightly from 62 to 55 mmHg and therapy was prolonged to 15 h. Pulmonary artery pressure dropped to 46 mmHg after 15 h. The patient was discharged from hospital at Day 7, and echocardiography revealed no signs of right heart dysfunction.

Discussion: Dosage of the thrombolysis agent and duration of UACDT are still a matter of debate. Besides clinical parameters and transthoracic echocardiography, invasive real-time PAP monitoring during UACDT could facilitate important information for therapy guidance in selected cases.

Keywords: Case report; Pulmonary artery pressure; Pulmonary embolism; Ultrasound-assisted catheter-directed thrombolysis.

Publication types

Case Reports