ULTRASOUND-ASSISTED THROMBOLYSIS THERAPY FOR THE TREATMENT OF ACUTE PULMONARY EMBOLISM IN AN INTERMEDIATE-HIGH-RISK PATIENT WITH MULTIPLE COMORBIDITIES: A CASE REPORT

Venous thromboembolism is an event that occurs within two components: deep venous thrombosis and pulmonary embolism. With many risk factors including old age, hospitalization and recent surgeries, malignancies, and the use of oral contraceptives, it occurs to be a relatively common condition. The European Society of Cardiology divides patients with acute pulmonary embolism into high-risk pulmonary embolism, low-risk pulmonary embolism, intermediate-high-risk pulmonary embolism, and intermediate-low-risk pulmonary embolism. This division is made based on three main criteria: hemodynamic stability, right ventricular dysfunction, and elevated troponin levels. Patient management based on risk stratification plays a vital part during the treatment. A 57-year-old woman arrived at the emergency department with syncope, abrupt shortness of breath, and unusual pleuritic chest pain. The patient had hypertension, insulin-dependent diabetes mellitus, and coronary artery disease dating back to 2012, which began with an anterior myocardial infarction treated with a left anterior descending stent. The patient later required additional stents in the left coronary artery and circumflex artery due to restenosis. At the date of approach, a three-vessel coronary artery bypass graft procedure was performed on her a month ago. With this medical history and being assessed as an intermediate-high-risk group, she was considered a candidate for catheter-directed therapy. Ultrasound-assisted thrombolysis therapy was performed with EkoSonic® Endovascular System and the patient was discharged with a total cure. This case serves as an example regarding the issue of a proper approach to patient management.