Tratamiento urgente de la embolia pulmonar aguda mediante el sistema de aspiración por catéter Penumbra®

Acute pulmonary embolism (PE) is a potentially lethal complication of venous thromboembolic disease, with a mortality rate as high as 10%. In the long term, chronic PE may precipitate cardiopulmonary complications and disabling sequelae. These complications can be reduced through appropriate and timely diagnosis, classification and treatment. The treatment of acute PE varies from low to high complexity. An allocation according to a multidimensional scale including clinical, echocardiographic and biomarkers is used to assess the risk of major complications and mortality at 30 days. The benefit of pharmacological thrombolysis in patients with cardiogenic shock due to pulmonary embolism has demonstrated reductions of mortality. However, both systemic thrombolysis and endovascular therapy in patients without shock remains a controversial issue that justifies current research. We report the case of an adult patient presenting an intermediate risk PE, defined by the presence of right and elevated markers of myocardial injury and ventricular dysfunction. It was decided to perform an intraarterial pharmacological thrombolysis and mechanical thrombectomy using a controlled suction system (Penumbra System®, Penumbra Inc., USA). This device was originally developed and validated for the treatment neurothrombectomy, but no studies have assessed its potential application for endovascular therapy by catheter in cases of intermediate risk PE. We describe a first case submitted to catheter directed treatment of PE using Penumbra® system and fibrinolysis, which allowed us to obtain favourable results in terms of both clinical and hemodynamic variables, with no evidence of adverse events. Penumbra® could represent a complementary technique for catheter-directed treatment in selected cases of acute PE.