What are the AHA guidelines for catheter-based interventions in pulmonary embolism (PE)?

Updated: Jun 06, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Recommendations for catheter-based interventions include the following:

  • For patients with massive PE and contraindications to fibrinolysis, catheter embolectomy and fragmentation or surgical embolectomy is reasonable, depending on the expertise available (class IIa).
  • For patients with massive PE who remain unstable after receiving fibrinolysis, catheter embolectomy and fragmentation or surgical embolectomy is reasonable (class IIa).
  • For patients with massive PE who cannot receive fibrinolysis or who remain unstable after fibrinolysis, consider transfer to an institution experienced in either catheter embolectomy or surgical embolectomy if these procedures are not available and safe transfer can be achieved (class IIa).
  • Either catheter embolectomy or surgical embolectomy may be considered for patients with submassive acute PE judged to have clinical evidence of adverse prognosis (new hemodynamic instability, worsening respiratory failure, severe right ventricular dysfunction, or major myocardial necrosis) (class IIb).
  • Catheter embolectomy and surgical thrombectomy are not recommended for patients with low-risk PE or submassive acute PE with minor right ventricular dysfunction, minor myocardial necrosis, and no clinical worsening (class III).

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