Lokale Katheterlyse bei submassiver Lungenembolie unter besonderer Berücksichtigung des Fountain-Katheter-Systems - Akut- und Langzeitverlauf

Abstract

Background: The role of thrombolytic therapy (TT) in patients with submassive pulmonary embolism (PE), i.e. preserved systemic arterial pressure and right ventricular dysfunction (RVD), is still controversially debated. Methods: 46 patients with submassive PE received intrapulmonary TT, most of them with the Fountain-catheter-system. The catheter tip with multiple side holes for drug application was placed directly into the embolus thus preventing the thrombolytic agent (rtPA bolus followed by continuous infusion of urokinase) from draining to nonaffected vessels. Results: Pulmonary artery pressure fell to a clinically relevant extent (mean decrease systolic/mean/diastolic: 21/11/4 mm Hg), whereby patients with acute onset of PE related symptoms (< 7 days prior TT) profited more than those with subacute onset (> 7 days). Patients treated with the Fountain catheter showed an immediate PAS reduction of 9, 5 mm Hg after the bolus administration of rtPA. There were no complications attributable to the catheter-intervention. Two patients suffered from minor and one patient from major bleeding. No intracranial or lethal bleeding occurred. There was one recurrent PE and no death during hospital stay. During follow up (33, 7 + 18,8 months) two patients died of malignant disease. More than 75 % of the patients were in NYHA-class I or II. Patients treated with the Fountain-catheter and those with an acute onset of PE related symptoms (< 7 days) were more likely to be completely asymptomatic (Fountain 38 % vs. conventional catheter 27 %, acute onset 39 % vs. subacute onset 23 %). Five of 36 patients who underwent echocardiography showed mild to moderate signs of chronic right heart hypertension. Conclusions: Locally administered TT in patients with submassive PE is safe and effective and favourably affects in-hospital and long term outcome. The use of the Fountain-catheter-system allows for a direct infiltration of the embolus with the thrombolytic agent followed by a rapid fall in PAP.