Summary of case reports and studies where the INARI technique was used to treat PE.
| Study | Patient characteristics | Parameters of right heart strain | Unique features of the case | Outcomes |
|---|---|---|---|---|
| Patel et al. [26] | 63/M | RV/LV 2.7 | Systemic thrombolysis was contraindicated and the patient was stabilized with VA ECMO | Restoration of pulmonary artery segmental and subsegmental flow post procedure. A retrievable IVC filter was inserted |
| Bayona Molano et al. [27] | 53/M | NT-proBNP levels were 832 pg/mLPA pressure was 38 mmHg | Systemic thrombolysis was contraindicated due to recent brain surgeryPE was a thrombus in transit involving RA and PA | Decreased clot burden in the RA and PA with no evidence of right heart strain. PA pressure on post procedure echo was 14 mmHg |
| Patel et al. [28] | 59/M | Straightening of the interventricular septum and clockwise rotation of the cardiac apex are seen on CTATroponins 89.9 pg/mL | Thrombus in transit with thrombus migration from right ventricle to pulmonary arteries | Significantly reduced clot burden post procedure |
| Garza et al. [29] | 57/M | Troponin 509 pg/mL and right ventricle dilation on echo. Pulmonary artery pressure was 38 mmHg | Pulmonary artery pressure reduced to 29 mmHg post procedure | |
| Jones et al. [30] | 76/M | RV systolic pressure was 80–85 mmHg | Fibroelastoma mass disguised as a clot | RV systolic pressure was reduced to 40–45 mmHg post procedure |
| Agarwal et al. [31] | 51/F | Troponins 58 pg/mL. RV/LV 1.33. Right ventricle systolic pressure 45 mmHg | INARI and Impella were done in a single session as signs of RV failure led to the placement of Impella RP | Significant improvement in hemodynamic parameters in a week |
| Nezami et al. [32] | 88/F | Troponin 91 pg/mL | Large clot burden in RA, right ventricle, and pulmonary artery | Pulmonary artery pressure decreased from 46/13 mmHg to 28/9 mmHg |
| Saricilar et al. [33] | 82/F | Right ventricle systolic pressure 45 mmHg | Fat embolism in transit | Post op right ventricle pressure was 31 mmHg |
| Stadler et al. [34] | 55/F | End diastolic mid diameter of the right ventricle was 53 mmRV dilation on TTE | First case of PE with acute right heart failure, treated with thrombectomy outside the USAVA ECMO was also implanted | The end diastolic mid diameter of the RV was 36 mm post procedure |
| Mathbout et al. [35] | 37/M | RA pressure 12 mmHgElevated troponin | The second episode is most likely due to immobilization during long periods of driving | Post procedural CTA showed no clot burden and near restoration of pulmonary artery blood flowPulmonary artery pressure decreased from 80/40 mmHg to 55/18 mmHg |
| Mathbout et al. [35] | 79/M | The interventricular septum flattened and bent to the left, with an RV/LV ratio of about 1.68:1RV pressure 60/10 mmHg | The PA pressure improved to 50/10 mmHg from 60/20 mmHg with full recovery of blood flow to both sides of the lungs | |
| Mathbout et al. [35] | 48/F | RV pressure 50/6 mmHg | Recent prior hospitalization secondary to COVID-19 | Post procedure, PA pressure 30/12 mmHg from 50/24 mmHg |
| Pham et al. [36] | 62/F | Chest CT showed right heart strain | Thrombus in transit, extending from the RA to the RV outflow tractAn initial moderate clot was removed, but the remaining clot was pushed into the RV outflow tract and could not be extracted from the PA despite repeated suction attempts | PA pressure decreased from 48/18 mmHg to 40/10 mmHg |
| Pham et al. [36] | 78/F | Right heart strain seen on chest CT | Pulmonary artery pressure decreased from 41/21 mmHg to 32/20 mmHg | |
| Capanegro et al. [37] | 75/M | Right heart strain evident on chest CT and echo | Mean pulmonary artery pressure decreased from 18 mmHg to 12 mmHg | |
| Mahmudlu et al. [38] | 32/F | McConnell’s sign is present | VA ECMO assist was taken | Pulmonary artery pressure decreased from 72 mmHg to 30 mmHg |
CTA: computed tomography angiography; ECMO: extracorporeal membrane oxygenation; PE: pulmonary embolism; RV: right ventricular; RV/LV: RV to left ventricular; RA: right atrium.