ArticleJACC. Case reports2026
Low-Dose Systemic Thrombolysis as Rescue Therapy After Catheter-Directed Thrombectomy for High-Risk Pulmonary Embolism on VA-ECMO.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
backgroundCatheter-directed treatments (CDTs) are increasingly being used for high-risk pulmonary embolism (PE) instead of upfront systemic thrombolysis. CASE SUMMARY: A patient with massive PE presented with hemodynamic instability and right ventricular (RV) strain after 2 thrombectomies. Low-dose systemic thrombolysis was initiated while the patient was on venoarterial extracorporeal membrane oxygenation (VA-ECMO), which led to improved perfusion and gas exchange. DISCUSSION: This case highlights that systemic thrombolysis may offer advantages over CDT by providing global fibrinolysis, which can address diffuse distal clot burden and microvascular obstruction that focal CDTs may not fully treat. TAKE-HOME MESSAGES: In high-risk PE with shock and contraindications or failure of CDT, systemic thrombolysis remains the first-line reperfusion therapy. This case demonstrates that low-dose systemic alteplase can be safely administered on venoarterial extracorporeal membrane oxygenation to restore reperfusion and unload the failing right ventricular, leading to resolution of shock.
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