Background: Untreated massive pulmonary embolism (PE) results in mortality rate of approximately 30%, most frequently within the first few hours of onset and up to 50% 3-month mortality. Catheter-directed therapy (CDT), due to mechanical fragmentation of the clot, removal of obstructing thrombi from the main to distal pulmonary arteries and thrombolytic-enhanced clot lysis, offers rapid reducing of pulmonary artery pressure, right ventricle strain, and pulmonary vascular resistance while simultaneously increase systemic perfusion and facilitate right ventricle recovery. (1) Systemic thrombolytic application carries up to a 20% risk of major bleeding, including a 2% to 5% risk of intracranial hemorrhage and is unwillingly prescribed. (2) CDT offers interesting alternative since, due to local application, dose can be significantly reduced. So far, predominantly the proximal venous access sites, most often transfemoral or transjugular, were used. We report the results of first CDT treatments via the antecubital venous access.

Patients and Methods: 17 consecutive patients presenting with clinical diagnosis of acute PE confirmed by computed tomographic angiography from January to August 2016 were enrolled in the trial. CDT involved mechanical catheter fragmentation and the application of adjuvant thrombolytic therapy through a pigtail catheter positioned in the pulmonary artery.

Results: Technical success was achieved in all patients, and in all patients significant improvement in hemodynamics and pulmonary angiography was observed 12 h after procedure (Figure 1). There were no major periprocedural complications.

Conclusion: Catheter positioned in the pulmonary artery allows continuous assessment of pulmonary hemodynamics, follow-up angiography and additional intervention/s if needed. CDT via cubital vain is feasible in vast majority of patients, offers significant dose reduction with low periprocedural complications and should be considered as a first line treatment for acute PE in experienced centers.