| Summary: | QUESTION: What types of catheter-based invasive approaches are available today to treat acute pulmonary thromboembolism? Please give us a brief description of the techniques used. ANSWER: Catheter-directed therapy (CDT) to treat pulmonary thromboembolism falls into 3 different categories: mechanical thrombectomy, local thrombolysis, and a combination of both. Mechanical thrombectomy (MT) consists of thrombus fragmentation, aspiration or removal. Fragmentation consists of using CDT nonspecific devices such as pig-tail catheters (forced rotation inside the thrombus) or dilatation balloons to break down and fenestrate the thrombotic occlusion to improve flow towards completely occluded regions. This technique is not very precise or reproducible so as new specific devices appear it will probably fall into oblivion. It is often used as an early facilitator of aspiration or penetration of the thrombolytic drug. Thrombus aspiration or removal consists of using hollow catheters of different calibers to aspirate the thrombus. This technique is highly dependent on the age the thrombus (more effective the more acute the case is) and the caliber of the aspiration catheter. Nonspecific material for coronary interventions (guide catheters of up to 8-Fr) or structural or peripheral heart procedures can be used (long introducers or sheaths > 8 Fr),...
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