Treatment Procedure
Patients were taken to the hybrid operating room for EKOS APT after
stabilization of hemodynamic status with the support of VA-ECMO. For the
placement of the EkoSonic Endovascular System common femoral vein access
was established by placement of a bilateral 6 French vascular sheath.
Digital subtraction angiography was performed in two bilateral anterior
oblique projections with the pigtail diagnostic catheter positioned in
the main pulmonary artery. Once the location of a pulmonary arterial
thrombus was identified angiographically, the angiographic catheters
were exchanged for an EkoSonic infusion device, which was navigated over
a 0.035-inch angled guidewire, such that the distal tip of the EKOS
infusion catheter was positioned at the distal edge of the thrombus
under fluoroscopy (Figure 2).
Patients were transferred to the ICU for thrombolytic infusion with tPA
administered at a rate of 1 to 1.5 mg/hr (0.5 to 0.75 mg/hr through each
catheter, in case of bilateral PE). 1 mg bolus tPA per catheter was
administered to the patients before the overnight infusion. Normal
saline coolant was infused at a rate of 40 cc/hr, through the coolant
port of the EKOS infusion catheter.