- Should be considered:
- Where there are absolute contraindications to thrombolysis
- Where thrombolytic therapy has failed and the patient is critically ill
- Options include:
Percutaneous Catheter-Directed Thrombolysis / Embolectomy
- Involves insertion of a catheter into the pulmonary arteries via the femoral route
- Different approaches involve one or a combination of:
- Mechanical fragmentation
- Ultrasound fragmentation
- Thrombus aspiration
- In situ reduced-dose thrombolysis
- Overall procedural success rates in small studies have reached 87%
Surgical Embolectomy
- Carried out with cardiopulmonary bypass, with aortic cross-clamping and cardioplegic cardiac arrest
- Involves incision of the two main pulmonary arteries with the removal or suction of fresh clots
- Has favourable outcomes in small studies:
- Similar 30-day mortality to thrombolytic therapy
- Lower risk of stroke or re-intervention