Mechanical and Enzymatic Thrombolysis of Acute Pulmonary Embolus: Review of the Literature and Cases from Our Institution

Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States. Patients with massive PE have a high mortality rate, with two of every three deaths occurring in the first hour. The mainstay of treatment for PE is anticoagulation. However, when the patient is in extremis, intravenous lysis of the clot is indicated. Recently, mechanical fragmentation with or without pharmacologic thrombolysis has been shown to have a role in therapy for patients with massive PE, as well as in those patients who have a contra indication to anticoagulation. We discuss our experience with mechanical fragmentation in the treatment of PE and review the literature.