PMC9929660_01
Computed tomography pulmonary angiography showing simultaneous filling defects of the right and left pulmonary artery.
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Computed tomography (CT) pulmonary angiography showed simultaneous filling defects of the right and left PA: a diagnosis of massive PE was made (Figure 1).
Pulmonary angiography showed large thrombus. (A) Right pulmonary artery. (B) Left pulmonary artery.
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After placing a 24 French (Fr) flex introducer sheath into the right common femoral vein, a 5-Fr angled Pigtail catheter was advanced over a 0.035-inch guidewire to reach the pulmonary trunk; so a pulmonary angiography was performed: it confirmed a massive embolism, especially of the right PA, with angiographic Miller Index of 23 (Figure 2).
FlowTriever 2 aspiration catheter advanced in the right pulmonary artery.
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Fr aspiration catheter did not reach the artery due to poor support; thus, we used a Lunderquist Extra-Stiff guide wire (Cookmedical, Bloomington, USA) to advance successfully the FlowTriever 2 aspiration catheter in the main right PA (Figure 3); the main PA pressure of 28 mmHg was registered. At this point, the catheter captured a huge thrombus of about 15 cm in length extended from the right PA to the left PA, that was successfully aspirated and brought out from the catheter (Figure 4). Final angiography demonstrated angiographic Miller Index of 6 (Figure 5) and mean PA pressure was 16 mmHg.
Aspiration of a huge thrombus of about 15 cm in length.
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Fr aspiration catheter did not reach the artery due to poor support; thus, we used a Lunderquist Extra-Stiff guide wire (Cookmedical, Bloomington, USA) to advance successfully the FlowTriever 2 aspiration catheter in the main right PA (Figure 3); the main PA pressure of 28 mmHg was registered. At this point, the catheter captured a huge thrombus of about 15 cm in length extended from the right PA to the left PA, that was successfully aspirated and brought out from the catheter (Figure 4). Final angiography demonstrated angiographic Miller Index of 6 (Figure 5) and mean PA pressure was 16 mmHg.
Final pulmonary angiography. (A) Right pulmonary artery. (B) Left pulmonary artery.
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Fr aspiration catheter did not reach the artery due to poor support; thus, we used a Lunderquist Extra-Stiff guide wire (Cookmedical, Bloomington, USA) to advance successfully the FlowTriever 2 aspiration catheter in the main right PA (Figure 3); the main PA pressure of 28 mmHg was registered. At this point, the catheter captured a huge thrombus of about 15 cm in length extended from the right PA to the left PA, that was successfully aspirated and brought out from the catheter (Figure 4). Final angiography demonstrated angiographic Miller Index of 6 (Figure 5) and mean PA pressure was 16 mmHg.