CR55 Mechanical Thrombectomy as an Effective Treatment for Pulmonary Embolism in Intermediate-high risk patients.

INTRODUCTION/OBJECTIVES: Pulmonary embolism (PE) is a significant cause of hospitalization and death worldwide. Therapy controversies arise in intermediate high-risk patients without signs of hemodynamic instability but with clinical characteristics of more severe PE. This case report demonstrates a successful resolution of PE with endovascular mechanical thrombectomy. CASE PRESENTATION: A 75-year-old presented with right hemiparesis due to acute ischemic stroke. Brain CT showed no apparent signs of acute ischemia or hemorrhage and the patient was started on intravenous thrombolysis. MRI revealed a subacute ischemic lesion with hemorrhagic transformation during the diagnostic workup. A week later, the patient became dyspneic, hypoxic, and tachycardic. Pulmonary CT angiography showed acute pulmonary embolism of both pulmonary arteries with propagation in all lobar branches and right ventricular strain. Since the patient had recent intracranial bleeding, she had a contraindication for thrombolysis. The patient was referred to radiology and underwent an endovascular mechanical thrombectomy. Emboli were successfully aspirated using the 24 French Flowtriever aspiration system. Pulmonary artery pressures dropped from 50/30 to 30/15 mmHg, O2 saturation increased from 80 to 96% and heart rate returned to normal. The patient recovered successfully. CONCLUSION: This case illustrates that mechanical thrombectomy may be the optimal therapy in intermediate highrisk PE patients and cases when there is a contraindication for thrombolysis. It is a valuable minimally invasive alternative to surgical thrombectomy. Future research is needed to demonstrate the safety and superiority of this treatment modality over others in different PE patients. [ABSTRACT FROM AUTHOR]