Case Presentation. A 65-year-old female with squamous cell carcinoma of the uterus was admitted with acute dyspnea and hypotension. A computed tomography (CT) angiogram using the pulmonaryembolism (PE) protocol revealed evidence of multiple pulmonary emboli, with the largest thrombus in the left lower pulmonary artery branch (Figure 1A). A transthoracic echocardiogram (TTE) demonstrated evidence of right ventricular (RV) dilatation and dysfunction (Figure 1B). Her hemodynamic instability necessitated inotropic support. She had recently undergone resection of the cervix complicated by significant vaginal bleeding, and therefore was not deemed a candidate for thrombolytic therapy.
Percutaneous catheter-based rheolytic thrombectomy was performed using an AngioJet® DVX™ Catheter (Possis Medical, Inc., Minneapolis, Minnesota) advanced through a 75-cm long sheath placed into the left pulmonary artery (Figure 1C). Thrombectomy was successful, and a repeat echocardiogram revealed improvement in RV function. CT angiography confirmed a significant decrease of the thrombus burden in the pulmonary circulation (Figure 1D). The patient experienced marked and sustained improvement in her symptoms, and was successfully weaned off inotropic support.

Discussion. The current treatment of massive PE has been either thrombolysis or surgical embolectomy. Percutaneous rheolytic thrombectomy, however, has emerged as an alternative treatment in patients with contraindications to thrombolysis. This case illustrates the usefulness of the AngioJet® thrombectomy catheter in patients with contraindications to thrombolytics. Three-dimensional CT imaging demonstrated the effectiveness of treatment in this patient with massive PE.