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Zhang Q, Li Y, Zheng G, Li C, Pan Z, Shi S, Rong J. AngioJet thrombectomy in the treatment of pulmonary embolism complicated with left subclavian artery embolism: a case report. J Int Med Res 2024; 52:3000605241258141. [PMID: 38853428 PMCID: PMC11163922 DOI: 10.1177/03000605241258141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
Coexistence of pulmonary embolism (PE) and arterial thrombosis in a single patient is rare. Management of such cases is challenging because there is no unified standard on how to treat this type of disease. We herein report a case involving a 73-year-old man who was admitted to the hospital because of a 2-day history of chest tightness. Pulmonary computed tomography angiography revealed a filling defect of the main pulmonary artery and bilateral branches as well as a left subclavian artery embolism. AngioJet mechanical thrombectomy (Boston Scientific, Marlborough, MA, USA) was used to treat the PE, and this was combined with left brachial artery incision and thrombectomy for treatment of the left subclavian artery embolism. The patient recovered well after the operation. The prognosis was good after 9 months of regular follow-up. AngioJet mechanical thrombectomy combined with left brachial artery incision thrombectomy may be a feasible treatment option for cases of PE combined with left subclavian artery embolism.
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Affiliation(s)
- Qiang Zhang
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Yang Li
- Suzhou Vocational Health College, Suzhou, China
| | - Guangfeng Zheng
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Chuanyong Li
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Zhichang Pan
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Shuming Shi
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Jianjie Rong
- Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
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Gong M, Zhao Q, Jiang R, Liu Z, Zhao B, Kong J, He X, Gu J. AngioJet rheolytic thrombectomy coupled with dose-reduced rt-PA for massive inferior vena cava filter-related thrombosis: A single-center retrospective study. Asian J Surg 2024; 47:263-268. [PMID: 37798188 DOI: 10.1016/j.asjsur.2023.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of AngioJet rheolytic thrombectomy (ART) coupled with dose-reduced rt-PA, compared to catheter-directed thrombolysis (CDT) alone, for the treatment of massive inferior vena cava filter (IVCF)-related thrombosis. METHODS We conducted a retrospective analysis of 40 patients who received either ART or CDT alone as the first-line endovascular therapy (ET) between January, 2016 and September, 2022. The data on demographics, clinical characteristics, technical success, clinical success, complications, and early follow-up were reviewed. RESULTS Of the 40 included patients, 24 received ART and 16 received CDT alone. The demographics, presentation, lesion characteristics, comorbidities and risk factors were comparable (all p > .05). Technical success rates were 100% in both groups. The total CDT time and infusion agent dosage were lower in the ART group than those in the CDT group (both p < .05). At the end of CDT, clinical success was 81.8% in the ART group, which was slightly higher than that of 70.8% in the CDT group (p > .05). At the 6-month follow-up, the incidences of recurrent thrombosis in the two groups were 6.9% and 15.8%, respectively, and the incidence of post-thrombotic syndrome was 10.3% and 21.1%, respectively. However, these differences were not statistically significant (p > .05). No major complications were noted in either group, ART seemed to have slightly higher risk of transient macroscopic hemoglobinuria and recoverable acute kidney injury, but with a lower minor bleeding incidence when compared with CDT alone (4.2 vs. 31.3%, p < .05). CONCLUSIONS ART or CDT alone as the first-line ET for IVCF-related thrombosis has comparable outcomes but with different adverse event profiles. Both modalities are safe and effective in patients with massive IVCF-related thrombosis.
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Affiliation(s)
- Maofeng Gong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Qing Zhao
- Department of Gastroenterology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, PR China
| | - Rui Jiang
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Zhengli Liu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Boxiang Zhao
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Jie Kong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Xu He
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Jianping Gu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China.
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Gong M, Fu G, Liu Z, Zhao B, Kong J, He X, Gu J. Angiojet pharmacomechanical thrombectomy versus anticoagulant therapy alone in massive cancer-associated thrombosis: a single centre retrospective cohort study. J Thromb Thrombolysis 2023; 55:365-375. [PMID: 36630028 DOI: 10.1007/s11239-023-02770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/12/2023]
Abstract
The therapeutic regimen option for the cancer-associated thrombosis (CAT) patients is still a major clinical challenge. The present study aimed to investigate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) with AngioJet treatment compared with the conventional anticoagulation alone therapy in the patients with CAT. We retrospectively reviewed the patients who underwent PCDT and/or anticoagulation for the treatment of CAT between August 1, 2016 and March 1, 2022. Each patient was divided into the PCDT group or the anticoagulation alone group. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were reviewed. A total of 51 eligible patients were included, of whom 21 were in PCDT group (mean age, 60.1 ± 13.0 years; 52.4% male) and 30 in anticoagulation alone group (mean age, 66.6 ± 11.1 years; 50.0% male). No significant differences regarding age, sex, onset time, limb characteristics, cancer conditions or risk factors were detected (p > .05). After PCDT, grade III lysis was achieved in 8 and grade II lysis in 11 patients. Clinical success was achieved in 90.5% (19/21) patients. The symptoms of leg pain and swelling were significantly improved in both groups. Except for transient macroscopic hemoglobinuria occurring in PCDT group, none of all patients suffered from procedure-related and major complications. Minor complications such as bleeding events occurred in 23.8% (5/21) of patients in PCDT group compared with 10.0% (3/30) in anticoagulation alone group (p > .05). At the 6-month follow-up, iliofemoral patency was found an absolute risk reduction of 37.9% (70.0 vs. 32.1%) (95% CI: 1.183-4.008%; P = 0.010). The incidence of mild PTS was 5.0% (1/20) in PCDT group compared with 10.7% (3/28) in anticoagulation alone group (p > .05). The PCDT is a safe and effective modality in managing patients with CAT, leading to improved clinical outcomes with a low complication. The PCDT was more effective than anticoagulation alone in massive symptom relief and venous patency.
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Affiliation(s)
- Maofeng Gong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China
| | - Guanqi Fu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China
| | - Zhengli Liu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China
| | - Boxiang Zhao
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China
| | - Jie Kong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China
| | - Xu He
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
| | - Jianping Gu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
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Seyedmirzaei Sarraf S, Rokhsar Talabazar F, Namli I, Maleki M, Sheibani Aghdam A, Gharib G, Grishenkov D, Ghorbani M, Koşar A. Fundamentals, biomedical applications and future potential of micro-scale cavitation-a review. LAB ON A CHIP 2022; 22:2237-2258. [PMID: 35531747 DOI: 10.1039/d2lc00169a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Thanks to the developments in the area of microfluidics, the cavitation-on-a-chip concept enabled researchers to control and closely monitor the cavitation phenomenon in micro-scale. In contrast to conventional scale, where cavitation bubbles are hard to be steered and manipulated, lab-on-a-chip devices provide suitable platforms to conduct smart experiments and design reliable devices to carefully harness the collapse energy of cavitation bubbles in different bio-related and industrial applications. However, bubble behavior deviates to some extent when confined to micro-scale geometries in comparison to macro-scale. Therefore, fundamentals of micro-scale cavitation deserve in-depth investigations. In this review, first we discussed the physics and fundamentals of cavitation induced by tension-based as well as energy deposition-based methods within microfluidic devices and discussed the similarities and differences in micro and macro-scale cavitation. We then covered and discussed recent developments in bio-related applications of micro-scale cavitation chips. Lastly, current challenges and future research directions towards the implementation of micro-scale cavitation phenomenon to emerging applications are presented.
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Affiliation(s)
- Seyedali Seyedmirzaei Sarraf
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
| | - Farzad Rokhsar Talabazar
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
| | - Ilayda Namli
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
| | - Mohammadamin Maleki
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
| | - Araz Sheibani Aghdam
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
| | - Ghazaleh Gharib
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
- Center of Excellence for Functional Surfaces and Interfaces for Nano-Diagnostics (EFSUN), Sabanci University, Orhanli, 34956, Tuzla, Istanbul, Turkey
| | - Dmitry Grishenkov
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, SE-141 57 Stockholm, Sweden
| | - Morteza Ghorbani
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
- Center of Excellence for Functional Surfaces and Interfaces for Nano-Diagnostics (EFSUN), Sabanci University, Orhanli, 34956, Tuzla, Istanbul, Turkey
| | - Ali Koşar
- Faculty of Engineering and Natural Science, Sabanci University, 34956 Tuzla, Istanbul, Turkey.
- Sabanci University Nanotechnology Research and Application Center, 34956 Tuzla, Istanbul, Turkey
- Center of Excellence for Functional Surfaces and Interfaces for Nano-Diagnostics (EFSUN), Sabanci University, Orhanli, 34956, Tuzla, Istanbul, Turkey
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Nagraj S, Li W, Zamora C, Barakakis PA, Kokkinidis DG. Pharmacological and interventional management of pulmonary embolism: where do we stand? Future Cardiol 2022; 18:191-206. [PMID: 35133192 DOI: 10.2217/fca-2021-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
As the third most common cardiovascular disease, pulmonary embolism (PE) has an uptrending incidence and mortality, resulting in significant healthcare expenditure. Risk stratification of acute PE guides management. Although anticoagulation remains the cornerstone management, systemic fibrinolysis and targeted therapeutic approaches, catheter-directed thrombolysis and catheter-based embolectomy are available for high-risk patients. Life-threatening bleeding complications associated with systemic fibrinolysis have restricted its widespread implementation. Catheter-based techniques for intermediate high-risk categories were devised to reduce bleeding complications and improve outcomes. Catheter-directed thrombolysis helps minimize bleeding by way of direct drug delivery. Catheter-based embolectomy mechanically retrieves thrombi without using fibrinolytics. This focused review of medical and interventional management of acute PE provides a highlight of ongoing trials expected to add value to current practice.
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Affiliation(s)
- Sanjana Nagraj
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Weijia Li
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Cristian Zamora
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | | | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale University School of Medicine, CT 06510, USA
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Ribas J, Valcárcel J, Alba E, Ruíz Y, Cuartero D, Iriarte A, Mora-Luján JM, Huguet M, Cerdà P, Martínez-Yélamos S, Corbella X, Santos S, Riera-Mestre A. Catheter-Directed Therapies in Patients with Pulmonary Embolism: Predictive Factors of In-Hospital Mortality and Long-Term Follow-Up. J Clin Med 2021; 10:jcm10204716. [PMID: 34682839 PMCID: PMC8537142 DOI: 10.3390/jcm10204716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Catheter-directed therapies (CDT) may be considered for selected patients with pulmonary embolism (PE); (2) Methods: Retrospective observational study including all consecutive patients with acute PE undergoing CDT (mechanical or pharmacomechanical) from January 2010 through December 2020. The aim was to evaluate in-hospital and long-term mortality and its predictive factors; (3) Results: We included 63 patients, 43 (68.3%) with high-risk PE. All patients underwent mechanical CDT and, additionally, 27 (43%) underwent catheter-directed thrombolysis. Twelve (19%) patients received failed systemic thrombolysis (ST) prior to CDT, and an inferior vena cava (IVC) filter was inserted in 28 (44.5%) patients. In-hospital PE-related and all-cause mortality rates were 31.7%; 95% CI 20.6-44.7% and 42.9%; 95% CI 30.5-56%, respectively. In multivariate analysis, age > 70 years and previous ST were strongly associated with PE-related and all-cause mortality, while IVC filter insertion during the CDT was associated with lower mortality rates. After a median follow-up of 40 (12-60) months, 11 more patients died (mortality rate of 60.3%; 95% CI 47.2-72.4%). Long-term survival was significantly higher in patients who received an IVC filter; (4) Conclusions: Age > 70 years and failure of previous ST were associated with mortality in acute PE patients treated with CDT. In-hospital and long-term mortality were lower in patients who received IVC filter insertion.
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Affiliation(s)
- Jesús Ribas
- Pneumology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (Y.R.); (S.S.)
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-260-7685
| | - Joana Valcárcel
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Radiology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Esther Alba
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Radiology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Yolanda Ruíz
- Pneumology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (Y.R.); (S.S.)
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
| | - Daniel Cuartero
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Adriana Iriarte
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - José María Mora-Luján
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Marta Huguet
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Critical Care Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Pau Cerdà
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Neurology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Xavier Corbella
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
| | - Salud Santos
- Pneumology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (Y.R.); (S.S.)
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Antoni Riera-Mestre
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
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