-Review-

Recent Advances in Interventional Radiology for Acute Massive Pulmonary Thromboembolism

Hiroyuki Tajima¹, Satoru Murata¹, Tatsuo Kumazaki¹, Ken Nakazawa¹, Kazuo Ichikawa¹, Tsuyoshi Yamamoto², Keiji Tanaka² and Teruo Takano²

¹Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School
²Department of Internal Medicine (I), Coronary Care Unit, Nippon Medical School

Acute massive pulmonary thromboembolism is life-threatening and requires vigorous treatment. Anticoagulation is the most traditional treatment for pulmonary thromboembolism, but may not be sufficient for massive thromboemboli. Systemic thrombolytic therapy and surgical thrombectomy are the traditional therapeutic options in this situation. Catheter-directed thrombolysis, percutaneous embolectomy and, more recently, percutaneous thrombus fragmentation techniques using specialized devices are now available to treat the most severe cases of massive pulmonary thromboembolism. The success of these techniques depends on a thorough understanding of the mechanism of action of each of the devices and familiarity with the relevant catheterization techniques. We present a review of currently available equipment and techniques, and describe our work with hybrid treatment using a combination of mechanical fragmentation, localized fibrinolysis and clot aspiration.

J Nippon Med Sch 2005; 72: 74-84

Keywords
pulmonary embolism, interventional procedure, thrombolysis, thrombectomy, catheters and catheterization

Correspondence to
Hiroyuki Tajima, Department of Radiology, Center for Advanced Medical Technology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
h-tajima@nms.ac.jp

Received, October 25, 2004
Accepted, November 30, 2004