The PENUMBRA Lightning 12 system for treatment of acute intermediate-high pulmonary embolism. Initial experience in Pulmonary Circulation Center Krakow, Poland

Lightning 12 is a next-generation catheter-directed aspiration thrombectomy system, which has recently been introduced to the European market for the reperfusion treatment of acute pulmonary embolism (PE) [1]. Larger size, 12 French embolectomy catheters and the innovative computer-aided aspiration system potentially translate into improved efficacy and safety. As yet, little evidence has been collected.
We aim to share our first experience with the use of this device.
A 61-year-old man with no identifiable venous thromboembolism risk factors was admitted to a district hospital emergency room due to sudden dyspnea with syncope. He had a four-day history of right limb deep venous thrombosis and progressing decrease of exercise capacity. At admission he was normotensive with systolic blood pressure (SBP) of 110 mm Hg, had tachycardia of 120–150 beats per minute (bpm) and hypoxemia with arterial blood oxygen saturation (SatO2) of 80% improving to 88% on mask oxygen supplementation. Computed tomography pulmonary angiography (CTPA) showed bilateral, central clots and a right-to-left ventricular ratio (RV/LV ratio) of 2.0 (Figure 1). Simplified Pulmonary Embolism Severity Index of 2 with radiological and laboratory signs of the RV dysfunction (blood level of high-sensitivity troponin T levels was 0.107 ng/ml (N < 0.014)) indicated intermediate-high risk of early death according to the European Society of Cardiology guidelines [2]. Low-molecular weighted heparin was the initial treatment. As there was no improvement in the clinical status, vital signs, or RV function during 12 h of anticoagulation together with increasing blood levels of troponins, the patient was transferred to the John Paul II Hospital Pulmonary Embolism Response Team (PERT) in Krakow. The indication for reperfusion therapy was determined by the PERT, composed of a PE invasive specialist and cardiac surgeon, and the patient underwent an urgent catheter-directed procedure. Mechanical thrombectomy using the Lightning 12 system, Indigo 12 XTORQ aspiration catheter and Separator 12 was performed from femoral vein access aiming for rapid RV debulking. Right and left pulmonary intermediate arteries and segmental arteries of the lower, middle and upper lobes of the right and lower lobes of the left lung were targeted, leading to evacuation of massive clots (Figure 1). Hemodynamic parameters including right atrial and pulmonary artery pressures improved from 14 to 13 mm Hg and 65/24/39...


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