The

n e w e ng l a n d j o u r na l

of

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Images in Clinical Medicine

LindseyR. Baden, M.D., Editor

Percutaneous Rotational Pulmonary

Thrombectomy
A

B
I

aVR

V1

V4

II

aVL

V2

V5

C
III

aVF

V3

V6

II

77-year-old woman was admitted to the emergency department Abdurrahman Oguzhan, M.D.
4 hours after the sudden onset of chest pain, palpitations, and dyspnea. Her Erciyes University School of Medicine
blood pressure was 60/40 mm Hg. An electrocardiogram showed sinus Melikgazi Kayseri 38039, Turkey
tachycardia, right bundle-branch block, S1Q3T3 pattern, and ST-segment elevation abdurrahmano@hotmail.com
in the inferior leads that mimicked myocardial infarction (Panel A, arrows). Transthoracic echocardiography was performed at the bedside; the right ventricle chamber seemed larger than the left ventricle chamber, with severe tricuspid regurgitation.
The patient was brought to the catheter laboratory for evaluation, and her coronary
arteries were found to be normal. She received a diagnosis of pulmonary emboli
with bilateral extensive thrombi in the proximal pulmonary arteries (Panels B and C,
arrows). A 6-French pigtail catheter was advanced into the embolus site and then
showing
rotated back to the desired position (Video). Tissue plasminogen activator was Athevideo
use of a
subsequently delivered directly into the clot through the pigtail catheter. The pa- pigtail catheter
tient was given norepinephrine to stabilize her hemodynamic status and then trans- is available at
ferred to the intensive care unit. Tissue plasminogen activator was administered NEJM.org
over the next 90 minutes, and therapy with unfractionated heparin was initiated.
Repeat transthoracic echocardiography performed at the bedside revealed impaired right ventricular function, dilatation of the right chamber of the heart with
severe tricuspid regurgitation, elevated systolic pressure of the pulmonary artery
(45 mm Hg), and preserved left ventricular function. The next day, the patient had
a cardiac arrest as a result of cardiogenic shock due to right ventricular failure and
died despite resuscitative efforts.

DOI: 10.1056/NEJMicm1415847
Copyright 2016 Massachusetts Medical Society.

n engl j med 374;1nejm.org January 7, 2016

The New England Journal of Medicine

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