Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP C-195
A Case Report: Successful Revascularization With Modified Catheter-Directed Thrombolysis in Patient With Acute Pulmonary Embolism.
By I Gede Sumantra, Pintoko Tedjokusumo, Saraswati Putri Yogita
Presenter
I Gede Sumantra
Authors
I Gede Sumantra1, Pintoko Tedjokusumo1, Saraswati Putri Yogita2
Affiliation
Bandung Adventist Hospital, Indonesia1, Puri Raharja General Hospital, Indonesia2,
View Study Report
TCTAP C-195
STRUCTURAL HEART DISEASE - Pulmonary Intervention: CTEPH, PHTN
A Case Report: Successful Revascularization With Modified Catheter-Directed Thrombolysis in Patient With Acute Pulmonary Embolism.
I Gede Sumantra1, Pintoko Tedjokusumo1, Saraswati Putri Yogita2
Bandung Adventist Hospital, Indonesia1, Puri Raharja General Hospital, Indonesia2,
Clinical Information
Patient initials or Identifier Number
DD
Relevant Clinical History and Physical Exam
A 62 year of age female presents to the ER with a worsening shortness of breath with no prior known medical history. She had motorcycle accident with non fixation of close fracture left distal tibia and fibula. She had Cardiogenic shock and oxygen desaturation. Echocardiography and ECG was performed with sign of acute pulmonary embolism (PE). The patient with high risk PE was planned invasive strategy with pulmonary angiography and catheter directed thrombolysis (CDT).
Relevant Test Results Prior to Catheterization
Initial investigation showed elevated of troponin, NT pro BNP and D Dimer.
Relevant Catheterization Findings
Pulmonary angiography showed large thrombus at left main pulmonary artery.
Interventional Management
Procedural Step
The patient was treated with initial reperfusion and hemodynamic support of dobutamine 10 mcg/kg/min, norepinephrine 0.1 mcg/kg/min, enoxaparine 2x0.6 cc sc, meropenem 3x1 gram. The patient was then planned for reperfusion strategy with catheter directed thrombolysis (CDT). CDT was done via access to the right femoral vein with a floppy wire crossed right atrium, right ventricle and main pulmonary artery. Modified Judkins right 3.5 7F with side holes placed at left pulmonary artery and started with manual thrombus aspiration. Fibrinolytic agent r-TPA (Ateplase) 0.01 mg/min max 20 mg/24h was inserted via catheter JR and 5000 IU bolus UFH continued with infusion UFH 15 U/kg with an APTT target 1.2-1.7 times normal. After 24 hours of post-CDT, patient showed a total r-TPA 30 mg was inserted. Hemodynamic patient was increased without support. An echocardiography evaluation showed negative McConnel’s sign and increased of RV function. Pulmonary hagiography evaluation showed good result of revascularization of Pulmonary artery branch. After CDT termination and follow up, direct oral anticoagulants were initiated. Patient went through ORIF cruris sinistra on day 7 and was finally discharged on day 11.
Case Summary
Here we demonstrated a successful treatment of catheter directed thrombolysis in acute pulmonary embolism. Surgical embolectomy is an established and effective method to unload the RV in high risk PE with a current in hospital mortality rate of 19.8%. Consistency of study showed that CDT reduced LV/RV ratio I within 24-48 hours. Catheter-directed methods, with or without low-dose thrombolytics, may emerge as an alternative to full-dose systemic thrombolytic treatment, as the haemorrhagic risk and elderly patients and those with high surgical risk.