Background: Pulmonary embolism (PE) is common, and it is the third leading cause of cardiovascular death. The management of patients with high-risk PE generally consists of systemic thrombolysis; however, surgical or catheter-directed treatment (CDT) can be considered in selected cases.
Case summary: A 78-year-old female patient presenting with acute severe dyspnoea develops out-of-hospital cardiac arrest (OHCA). She was admitted with return of spontaneous circulation and a critical haemodynamic state upon arrival to the catheterization laboratory with an estimated no-flow time of 1 min and low-flow time of 52 min. An acute pulmonary angiogram reveals massive PE. After a PE response team conference, the patient was not found eligible for extracorporeal membrane oxygenation, surgery, or thrombolysis. The patient was treated with catheter-directed mechanical thrombectomy 129 min after first medical contact. The patient recovered and was discharged without any neurological deficits.
Discussion: Catheter-directed mechanical thrombectomy was a successful treatment in a patient with OHCA secondary to high-risk PE, where thrombolysis and surgical interventions were considered contraindicated. This case underlines the future perspectives of CDT and also that a multidisciplinary team approach may benefit patients with high-risk PE.
Keywords: Case report; Catheter-directed treatment; PERT; Pulmonary embolism.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.