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Successful Treatment of Right Heart Thrombus and High-Risk Pulmonary Embolism with Acoustic Pulse Thrombolysis Using EKOS Endovascular System

Currently, the only widely accepted indication for interventional
treatment in cases of pulmonary embolism is hemodynamic instability or
cardiogenic shock. However, the presence of a right-heart thrombus along
with a pulmonary embolism is a poor prognostic indicator, and
catheter-directed thrombolysis with the use of thrombolytic agents
should also be considered in this circumstance. Optimal management of
right heart thrombus and high-risk pulmonary embolism is still
uncertain. Herein, we present the case of an 81-year-old woman who
presented at our hospital after progressive dyspnea and a syncopal
event. The transthoracic echocardiography showed massive bilateral
pulmonary, right ventricular, and mobile atrial thrombus and also
right-sided enlargement. The patient was successfully treated with
acoustic pulse thrombolysis using the EKOS EkoSonic system and
echocardiography revealed complete resolution of her right-heart
thrombus and her high-risk pulmonary embolism 2 days later.