Catheter-directed thrombolysis in a COVID-19 patient complicated with pulmonary embolism

Area of Science:

• Cardiology
• Infectious Diseases
• Neurology

Background:

• The novel coronavirus (COVID-19) outbreak has led to significant global morbidity and mortality.
• COVID-19 is strongly linked to thromboembolic events, such as deep venous thrombosis and pulmonary embolism (PE).
• Catheter-directed thrombolysis (CDT) is an established reperfusion therapy for PE.

Observation:

• A patient with intermediate-risk PE, a history of COVID-19 infection, and ischemic stroke presented with a saccular anterior cerebral artery aneurysm.
• The patient had a high risk of bleeding, precluding full-dose systemic thrombolytic therapy.
• CDT was selected as the preferred reperfusion strategy due to the patient's high bleeding risk.

Findings:

• CDT was successfully performed for intermediate-risk PE in a patient with recent COVID-19 and a cerebral aneurysm.
• The patient experienced a high bleeding risk, making systemic thrombolysis contraindicated.
• The patient was discharged uneventfully four days post-procedure.

Implications:

• CDT represents a safe and effective alternative for managing intermediate-risk PE in patients with elevated bleeding risks.
• This approach is particularly relevant for patients with comorbidities like recent COVID-19 infection and cerebrovascular conditions.
• Minimally invasive reperfusion strategies like CDT are crucial for optimizing outcomes in complex PE cases.