PMC6956464_01
A - Angiogram of the left pulmonary artery before the procedure. Right anterior oblique 30  projection was used to determine the segmental arteries accurately. The massive thrombus affecting lower lobar arteries is visible. B - Angiogram after continuous aspiration thrombectomy with Indigo 8 Fr catheter. The thrombus was fragmented and mostly removed, but distal embolization of segmental branches of the intermediate lobe and lower lobe (white arrows) prompted us to continue aspiration. 6 Fr Judkins Right coronary catheter and coronary guidewire were used to selectively intubate segmental arteries and to restore the flow. C - Aspirated thrombi from the pulmonary artery. D - ECG before the procedure. Sinus rhythm of 115/min with right bundle branch block and signs of right ventricular overload. ECG on next day after the procedure revealed sinus rhythm of 88/min. RBBB completely subsided
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The thrombus was fragmented and partially removed (Figure 1 B) but distal embolization in the intermediate branch and lower segmental branches appeared (A4-5, A10). For this reason we continued aspiration and entered selectively segmental branches using the support of 6 Fr Judkins Right diagnostic coronary catheter and 0.014'' coronary guide-wire to restore and improve the pulmonary flow (Figure 1 B). On the second day after the procedure normalisation of ECG (Figure 1 D) and echocardiography were obtained and SaO2 increased to 96% (without oxygen supplementation).