Catheter-Directed Pulmonary Reperfusion in Treatment of Pulmonary Embolism Patients
Pulmonary Embolism
About this trial
This is an interventional treatment trial for Pulmonary Embolism focused on measuring pulmonary embolism
Eligibility Criteria
Inclusion Criteria:
- Age >18 years old.
- Both gender males and females.
- Patients with angiographically confirmed acute high risk pulmonary embolism with shock index >1.
- pulmonary arterial occlusion with >50% involvement of the central (main and/or lobar) pulmonary, and dysfunction of the right ventricle and elevated troponin.
- patients with high risk pulmonary embolism who remain unstable after receiving fibrinolysis
- patients with high risk PE pulmonary embolism who cannot receive fibrinolysis
- patients with intermediate high risk PE pulmonary embolism with adverse prognosis (new hemodynamic instability, worsening respiratory failure, severe RV (right ventricle) dysfunction, or major myocardial necrosis)
Exclusion Criteria:
- patients with echocardiographically confirmed right sided thrombi.
- patients with low-risk PE pulmonary embolism or submassive acute PE pulmonary embolism with minor RV (right ventricle) dysfunction, minor myocardial necrosis, and no clinical worsening
- Anaphylactic reaction to contrast media.
- Acute renal failure or severe chronic non-dialysis dependent kidney disease.
- Uncooperative patient
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm 3
No Intervention
Active Comparator
Active Comparator
systemic thrombolysis group
mechanical fragmentation group
In Situ thrombolysis group
patients without any contraindications for systemic fibrinolytic therapy will be treated with traditional systemic thrombolysis (intravenous administration of streptokinase).
patients will be treated with catheter-directed mechanical fragmentation under fluoroscopy guidance. This group will include patients with absolute contraindication for fibrinolytic therapy.
patients will be treated with bed side administration of low dose of local thrombolytic therapy (In Situ) via a trans-Jugular Swan-Ganz pulmonary artery catheter. with guidance of the pressure waveforms obtained from SGC(Swan-Ganz pulmonary artery catheter) and echocardiography guidance for ideal Catheter placement. This group will include the patients with relative contraindications for systemic thrombolysis, contraindications for contrasted administration (patients with renal impairment) and also patients with contraindications for radiation exposure (pregnant women).