Acute massive pulmonary embolism: use of a rotatable pigtail catheter for diagnosis and fragmentation therapy.

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Abstract
A modified pigtail catheter for angiographic documentation and mechanical fragmentation of pulmonary embolism was evaluated for its efficacy and safety. Rotation of the 5-F pigtail catheter was performed with an electric drive or a handle. The wire left an oval side hole at the outer curvature and served as an axis of rotation. Fragmentation properties were assessed in vitro. Pulmonary positioning, steerability, rotation behavior, and safety were tested in six pigs. Pulmonary embolic occlusions were recanalized in eight dogs. The catheter system was promptly positioned and easily steered in the pulmonary arteries. On average, 53% of the occluded pulmonary arteries were recanalized. Recanalization reduced the emboli-induced elevation of the pulmonary artery mean pressure by 73%. Slight perivascular hemorrhage occurred in three dogs. Rapid partial recanalization was achieved with relative ease of instrumentation. The technique is an extension of the commonly performed pigtail catheterization of the pulmonary arteries, which may increase its clinical acceptance.

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