New pulmonary embolism technique saves lives

MORGANTOWN, W.Va. – Pulmonary embolisms – blood clots that become lodged in an artery in the lung, blocking blood flow – can cause the heart to struggle and can lead to heart failure or cardiac arrest. The standard, first line of care for pulmonary embolism is the clot-busting medication tissue plasminogen activator (TPA), which helps the body to break up and clear the clot so blood flow to the lungs can be restored. For some massive pulmonary embolisms, TPA is not enough.

In cases where medication does not provide sufficient clot removal or the patient is showing signs of cardiac decline, interventional radiologists must intervene to remove the clot. Traditionally catheter-directed thrombolysis, which requires access to the pulmonary artery using a catheter inserted through the neck or groin, is used to deliver TPA directly to the clot.

WVU Medicine interventional radiologists have implemented a new device to remove pulmonary embolisms in patients for whom TPA is not successful or is contraindicated or those who are experiencing cardiac decline that requires more immediate action. The Inari FlowTriever system allows interventional radiologists the ability to access the pulmonary artery and remove the clot from the body with immediate results.

“Before the procedure, these patients can often barely complete a sentence, answering questions one word at a time because they can’t take a full breath,” Robert Grammer, M.D., WVU Medicine interventional radiologist, said. “Because we can perform this procedure through a small incision and local anesthesia, we are able to see immediate effect when the clot is removed. Most patients cough a couple times, then are talking and telling us about how much better they feel and the story of how they came to the hospital that day.”

The implementation of this procedure eliminates the need for open heart surgery, which requires a large incision and long recovery period. 

Mike Malone, 62 of Oakland, Maryland, considers himself to be in excellent health and regularly rides his bike up to 60 miles, so when he suddenly experienced extreme shortness of breath, he knew it could be something serious.

“We’d just gotten home from a trip to visit our son in Baltimore, and, suddenly, I was extremely winded going up our stairs,” Malone said. “It was just like a light switch. I went from not having any problem at all to hardly being able to breathe, and my heart was racing.”

That’s when he and his wife decided it was time to drive to WVU Medicine J.W. Ruby Memorial Hospital, where doctors discovered he had a massive pulmonary embolism.

“I went to the hospital on a Sunday, was released on Monday, and was back riding my bike by Friday because I didn’t have any pain with my incision,” Malone said.

“I’m not the type of person who goes to the doctor for every problem I have, but I’m glad I went for this. The doctors told me a lot of patients with the embolisms don’t make it to the hospital, so I’m glad I went when I did. I would tell anyone to go to the hospital right away if they feel like they can’t breathe because I know it saved my life.”

Patients who have had pulmonary embolisms require ongoing follow-up to monitor for new clots so they can be treated before they are life threatening.

Phil Remke, 68 of Moundsville, had just had triple bypass surgery when he felt like his recovery wasn’t going as it should. He was having chest pain and shortness of breath. He felt like he should push through it as part of his cardiac recovery, but soon his symptoms worsened. He knew something wasn’t right. 

“I told my family I’m in trouble, I can’t breathe,” Remke said. “We all thought it was because of the surgery, and I needed to push through it.”

He sent his wife to her Women’s Club meeting so she could get a break and decided to sit on the front porch for some fresh air. When that didn’t help, he started to walk inside, but couldn’t catch his breath. He called his son, who lives down the street, to come help him.

“We had a disabled son who passed away 13 years ago, and I still had his home fill oxygen system. I had my son start that up so I could use it,” Remke said. “I was able to catch my breath after using the oxygen.”

Remke has a history of pulmonary embolism, which was being treated and monitored by his physician. 

“My daughter called a few days later and said God told her to check my PE,” Remke said. “The doctors had checked it before my surgery but hadn’t since.”

He was scheduled for a routine follow-up visit with Walid Gharib, M.D., WVU Heart and Vascular Institute interventional cardiologist at WVU Medicine Reynolds Memorial Hospital, to monitor his pulmonary embolism in three weeks, but he knew he needed to act sooner. He called the office and was able to get an appointment that afternoon.

Dr. Gharib ordered an emergency CT scan to see if Remke’s pulmonary embolism had changed. After looking at the results, Gharib knew Remke needed immediate intervention. After Remke’s surgery, blood clots had traveled to his lungs, causing large blockages.

Remke was transferred to WVU Medicine Wheeling Hospital to be transported by a HealthNet helicopter to J.W. Ruby Memorial Hospital. When he arrived, intensive care physicians and interventional radiologists looked at his scan and determined he needed immediate surgery to remove the clots.

He underwent a three-and-a-half-hour surgery, which was longer than the average with this technique due to the complexity of his case, to remove the clots using the FlowTriever system. After the procedure, he was admitted to the MICU for the night before moving to the step-down unit the next day for further observation. 

“I was sitting in the recliner when my family came in, and they were surprised that I looked so much better,” Remke said. “I told them I felt fantastic. The physical therapist came later that day and asked me to walk a short distance to the wall and back. I told him I was going to do better than that, but I didn’t want any help. I walked around the whole floor, only stopping once to tell him about the work I’ve done in Moundsville.”

Now, Remke says he’s feeling much better and is able to walk long distances without feeling short of breath. He says his overall health has improved and his doctors have allowed him to stop taking the majority of the medications for his heart and other health conditions.

“I’m grateful to God and WVU Medicine in Morgantown,” Remke said. “I always told my family that I was going to live to 85, but now I feel like I could live to 185.”

For more information on WVU Medicine, visit WVUMedicine.org.