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Pulmonary Embolism Resolved with Site Specific Thrombolysis via Drug Delivery Catheter

Pulmonary Embolism Resolved with Site Specific Thrombolysis via Drug Delivery Catheter. Michael Nuyles , DO Interventional Cardiology Fellow Midwestern University Franciscan Alliance – Olympia Fields, IL Michael Nicholas, DO, FACC, FACOI Interventional Cardiology Program Director.

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Pulmonary Embolism Resolved with Site Specific Thrombolysis via Drug Delivery Catheter

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  1. Pulmonary Embolism Resolved with Site Specific Thrombolysis via Drug Delivery Catheter Michael Nuyles, DO Interventional Cardiology Fellow Midwestern University Franciscan Alliance – Olympia Fields, IL Michael Nicholas, DO, FACC, FACOI Interventional Cardiology Program Director

  2. Disclosures • None • $265,000 USD in medical school loans

  3. Active, 81 year old Caucasian Female presented with progressive debilitating dyspnea on exertion, chest tightness, and lightheadness.

  4. Case Presentation • Medical History: • HTN, Dyslipidemia, Mild TR (prior ECHO 2008) • Surgical History: • Hysterectomy • Social History: • Lifelong non-smoker, no EtOH/Illicits • Avid bicyclist, exercises daily

  5. Meds: • Simvastatin, ASA, Amilodipine, Atenolol • Family History: • No Hx of malignancy or coagulopathy • Physical Exam: • Afebrile , BP121/84, HR 81, RR 24, 94% on 4 liters O2 nasal cannula • CVS: RR, S1, S2 positive Carvallo’s Sign • Lungs: CTA • EXT: Tr Edema

  6. CT Angiography and Echo ECHO: - RV mod/severely dilated with reduced systolic function - Mod/severe TR - RVSP 57.1 mmHg CTA Chest: Extensive bi-lateral pulmonary emboli upper and lower lobe

  7. Procedural Course • 7Fr sheath via Right Internal Jugular Vein • 7Fr Ansel 1 Flexor peripheral sheath • Terumo ™ Glidewire-angled-stiff 180 cm Guidewire • 5Fr. Pigtail catheter with attempted unsuccessful mechanical thrombolysis

  8. Modern CDT vs. Systemic tPA(for Treatment of Acute PE) *Includes 1.3% major hemorrhages. **All were major hemorrhages. Courtesy of Anthony Venbrux, MD

  9. Intra-clot administration of tissue plasminogen activator (tPA) into the pulmonary arteries 8 mg total using a ClearWay™ drug delivery balloon OTW 4 .0 x 20 mm Procedural Course

  10. Pre and Post tPAPulmonary Artery Pressures Pre Intervention ECHO Post Intervention ECHO- Day 9

  11. Case Summary • Significant improvement of functional status and by echocardiographic evaluation • Hemodynamically stable post tPA infusion • Improved saturation requiring no supplemental oxygen 4 days post tPA infusion • Ambulated well with cardiac rehab services within 2 days post tPA infusion • Discharged home on Day 14 once INR therapeutic

  12. Conclusion • Significant risks associated with large boluses of tPA needed to resolve clot • Drug Delivered via Guide Catheter may not be adequate for dissolution of heavy thrombus burden • Site specific drug delivery is effective in quickly resolving pulmonary embolism with less drug utilized • Intra-clot delivery via an atraumatic drug delivery balloon holds great promise for managing thrombus burden and improving lung function

  13. Thank you!

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