Transbrachial Catheter-Assisted Thrombolysis and Bailout Stenting for Massive Postoperative Pulmonary Embolism

A 61-year-old patient developed acute dyspnea and hypoxemia 72 hours after open lung lobectomy. An urgent computed tomography angiography revealed an acute pulmonary embolism with complete left pulmonary artery occlusion.

The patient was referred for urgent catheterization by a multidisciplinary team due to bleeding risks. Using right transbrachial access, the left pulmonary artery was recanalized. After balloon angioplasty, intravascular imaging guided the optimal placement of a stent to resolve vessel recoil. Local low-dose thrombolysis was initiated after partial reopening. After 24 hours, control angiography showed significant improvement in pulmonary artery perfusion.

To our knowledge, this is the first reported case of using a coronary stent with local thrombolysis via brachial access to treat acute pulmonary embolism. The procedure successfully restored vessel patency with no complications. This case emphasizes the potential of catheter-based interventions, especially when intravenous thrombolysis is contraindicated.

Innovative catheter-based interventions with stenting and local thrombolysis via transbrachial approach may offer a valuable option for managing acute pulmonary embolism in select patients.