| Catheter-mediated thrombus fragmentation |
Rotating a pigtail catheter most commonly used, J-tipped wire |
Disrupt and macerate the thrombus sending small fragments distally. Used to immediately lower the right ventricular strain due to proximal thrombus in the pulmonary arteries |
Often used with thrombolytic but not always |
Kuo et al. (13)—Catheter-directed therapy for the treatment of massive pulmonary embolism: systemic review and meta-analysis of modern techniques |
| Kuo et al. (14)—Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry |
| Catheter-mediated thrombus aspiration |
Various guide catheters, sheaths, Indigo suction embolectomy device (Penumbra Inc., Alameda, CA, USA) |
Aspirate thrombus from the pulmonary arteries |
Option for patients with contraindication to thrombolytics |
Kuo et al. (13)—Catheter-directed therapy for the treatment of massive pulmonary embolism: systemic review and meta-analysis of modern techniques |
| Kuo et al. (14)—Pulmonary embolism response to fragmentation, embolectomy, and catheter thrombolysis (PERFECT): initial results from a prospective multicenter registry |
| Rheolytic thrombectomy |
AngioJet Thrombectomy System (Boston Scientific, Minneapolis, MN, USA) |
High flow saline jet produces negative pressure allowing aspiration of thrombus |
Angiojet device has an FDA black-box warning for use in the pulmonary arteries |
Kuo et al. (13)—Catheter-directed therapy for the treatment of massive pulmonary embolism: systemic review and meta-analysis of modern techniques |
| Thrombolytic infusion catheters |
Multi side-hole catheters |
After catheter placed across thrombus burden, thrombolytic infused over hours directly into thrombus |
Thrombolytic use with admission to the ICU |
Liang et al. (15)—Comparative outcomes of ultrasound-assisted thrombolysis and standard catheter-directed thrombolysis in the treatment of acute pulmonary embolism |
| Ultrasound-assisted thrombolytic infusion catheter |
EkoSonic Endovascular System (EKOS), (BTG International Inc., West Conshohocken, PA, USA) |
Thrombolytic side hole catheter with an ultrasound emitting wire that breaks up fibrin facilitating thrombolysis |
Thrombolytic use with admission to the ICU. Cost |
Kucher et al. (16)—Randomized, controlled trial of ultrasound-assisted catheter-directed thrombolysis for acute intermediate-risk pulmonary embolism |
| Piazza et al. (17)—A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II Study |
