Thirty-three studies (348 participants) were included: 25 case series and 8 case-reports.
Embolectomy with the Greenfield catheter was evaluated alone (7 studies, 89 patients) and in combination with thrombolytic agents (4 studies, 19 patients). Clinical success was achieved in 81% of patients when the Greenfield catheter was used alone and 100% of cases when used in combination with thrombolytic agents. Six major bleeding events occurred with the Greenfield catheter without thrombolysis, whereas no major bleedings were reported for the combination with thrombolytic agents. Perforation of the right ventricle and tricuspid insufficiency each occurred in one patient treated with the Greenfield catheter.
Embolectomy with fragmentation was evaluated without (4 studies, 11 patients) and with thrombolysis (18 studies, 178 patients). Fragmentation alone was used in only 3 patients, with clinical success reported in 2 of them. In combination with systemic and local thrombolytic agents, angiographic catheters obtained clinical success in 71% and 95% of patients, respectively. Embolectomy with the Amplatz catheter was associated with clinical success in 88% of cases when used alone, and in 100% when used in combination with thrombolytic agents (6 patients). Overall, 6 major bleedings were reported for the fragmentation technique. Right femoral nerve injury was reported in 1 patient after fragmentation embolectomy and thrombolytic therapy.
Embolectomy with the rheolytic technique was evaluated without thrombolysis in 3 studies (8 patients) and in combination with thrombolysis in 5 studies (43 patients). Clinical success was observed in 75% of patients treated with the rheolytic Angiojet alone. No studies evaluated the hydrolyser catheter alone. In combination with thrombolytic agents, the clinical success rate was 87% with the Angiojet catheter and 92% to 100% with the Hydrolyser catheter. No major bleeding events were reported for the rheolytic technique.
Overall, catheter-tip devices were associated with minor bleeding at the insertion site in 29 of 348 patients (8%), and with major bleeding at the insertion site in 8 of 348 patients (2%). There was no case of a pulmonary artery perforation.