Catastrophic High-Risk Pulmonary Embolism With Recurrent Cardiac Arrest Successfully Treated With Rescue Mechanical Thrombectomy After Systemic Thrombolysis
- 1Anesthesiology and Critical Care, Ospedale Antonio Cardarelli, Campobasso, ITA
- 2Cardiovascular Medicine, Ospedale Antonio Cardarelli, Campobasso, ITA
- 3Internal Medicine, Ospedale Antonio Cardarelli, Campobasso, ITA
Abstract
High-risk pulmonary embolism (PE) complicated by cardiac arrest carries an extremely high mortality, and the optimal rescue strategy after an inadequate response to systemic thrombolysis remains uncertain. We report the case of a 53-year-old woman with previous deep-vein thrombosis who was admitted after an out-of-hospital cardiac arrest and subsequently experienced three additional episodes of cardiac arrest with pulseless electrical activity. Computed tomography pulmonary angiography demonstrated extensive bilateral central PE with severe right ventricular dilation and interventricular septal shift. Systemic thrombolysis with alteplase was administered. Despite thrombolysis and vasopressor/inotropic support, persistent cardiogenic-obstructive shock, electrical instability, and severe right ventricular pressure overload remained. Approximately 4 h after thrombolysis, rescue mechanical aspiration thrombectomy was performed using the Indigo® Aspiration System with Lightning Flash™ (Penumbra, Inc., Alameda, CA, USA). Ultrasound-guided right common femoral venous access was obtained with an 18 F sheath, and aspiration was performed in both pulmonary arteries. Pulmonary artery pressure decreased from 34 mmHg before aspiration to 25 mmHg at the end of the procedure. The patient subsequently achieved progressive hemodynamic stabilization. After prolonged mechanical ventilation and tracheostomy, neurological recovery was favorable. At discharge, echocardiography showed normal biventricular systolic function. This case illustrates that prompt escalation to rescue mechanical thrombectomy may be considered in selected patients with high-risk PE when shock, electrical instability, and right ventricular overload persist despite systemic thrombolysis.
Related
- Cost-Effectiveness of Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Intermediate-Risk Pulmonary Embolism: A PEERLESS Randomized Controlled Trial Post Hoc Analysis
- Mechanical Thrombectomy for Pulmonary Tumor Embolism Masquerading as Bland Pulmonary Embolism: A Case Report.
- Large-bore Mechanical Thrombectomy for Treatment of Intermediate-high Risk Pulmonary Embolism: A Single-center Australian Experience.
- Effects of mechanical thrombectomy combined with anticoagulation vs anticoagulation monotherapy for acute intermediate-high risk pulmonary embolism: study protocol for a randomized controlled trial (CAPE study, ChiCTR2500095253, https://www.medicalresearch.org.cn/clinicalResearch/researchInfo?id=c57630b7-51ec-4b24-83e1-85b9c0a835d6).
- Bridging Thrombolysis Versus Direct Endovascular Thrombectomy in Acute Ischemic Stroke Patients With ASPECTS ≤5: A Meta‐Analysis
BibTeX
@article{cuzzone2026catastrophic,
title = {{Catastrophic High-Risk Pulmonary Embolism With Recurrent Cardiac Arrest Successfully Treated With Rescue Mechanical Thrombectomy After Systemic Thrombolysis}},
author = {Vincenzo Cuzzone and Alessia Di Bartolomeo and Nicola Porchetta and Francesco Scarati and Carmen Fierro},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117301},
url = {https://europepmc.org/article/PMC/PMC13723189},
note = {CC BY},
}
RIS
TY - JOUR
TI - Catastrophic High-Risk Pulmonary Embolism With Recurrent Cardiac Arrest Successfully Treated With Rescue Mechanical Thrombectomy After Systemic Thrombolysis
AU - Vincenzo Cuzzone
AU - Alessia Di Bartolomeo
AU - Nicola Porchetta
AU - Francesco Scarati
AU - Carmen Fierro
PY - 2026
DA - 2026/10/01
JO - Cureus
DO - 10.7759/cureus.117301
UR - https://europepmc.org/article/PMC/PMC13723189
AB - High-risk pulmonary embolism (PE) complicated by cardiac arrest carries an extremely high mortality, and the optimal rescue strategy after an inadequate response to systemic thrombolysis remains uncertain. We report the case of a 53-year-old woman with previous deep-vein thrombosis who was admitted after an out-of-hospital cardiac arrest and subsequently experienced three additional episodes of cardiac arrest with pulseless electrical activity. Computed tomography pulmonary angiography demonstrated extensive bilateral central PE with severe right ventricular dilation and interventricular septal shift. Systemic thrombolysis with alteplase was administered. Despite thrombolysis and vasopressor/inotropic support, persistent cardiogenic-obstructive shock, electrical instability, and severe right ventricular pressure overload remained. Approximately 4 h after thrombolysis, rescue mechanical aspiration thrombectomy was performed using the Indigo® Aspiration System with Lightning Flash™ (Penumbra, Inc., Alameda, CA, USA). Ultrasound-guided right common femoral venous access was obtained with an 18 F sheath, and aspiration was performed in both pulmonary arteries. Pulmonary artery pressure decreased from 34 mmHg before aspiration to 25 mmHg at the end of the procedure. The patient subsequently achieved progressive hemodynamic stabilization. After prolonged mechanical ventilation and tracheostomy, neurological recovery was favorable. At discharge, echocardiography showed normal biventricular systolic function. This case illustrates that prompt escalation to rescue mechanical thrombectomy may be considered in selected patients with high-risk PE when shock, electrical instability, and right ventricular overload persist despite systemic thrombolysis.
SN - 2168-8184
ER -