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Thrombolysis and Mechanical Fragmentation to Treat Massive Pulmonary Embolism in a Patient with an Anterior Communicating Artery Aneurysm

Purpose: To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm. Case Report: An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated. Conclusions: Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.