1. Volume 114, Issue 5, Pages 1427-1436 (November 1998)
Fragmentation of Massive Pulmonary Embolism Using a Pigtail Rotation Catheter 
Thomas Sckmitz-Rode, MD, Uwe Janssens, MD, Hans H. Schild, MD, Steffen Basche, MD, Peter Hanrath, MD, Rolf W. Günther, MD 
CHEST 
Volume 114, Issue 5, Pages (November 1998)
DOI: /chest
Copyright © 1998 The American College of Chest Physicians Terms and Conditions

2. FIGURE 1
Besides the two standard functions of a pigtail catheter (1, wire exiting the end hole and tip straightened for introduction and placement; 2, wire removed and pigtail recoiled for contrast injection), this special catheter is able to maintain a third tip configuration for embolus fragmentation: the wire is exiting the oval side hole proximal to the pigtail tip and serves as a directing axis crossing the embolic occlusion. The catheter shaft is rotated manually, and the embolus is fragmented by mechanical action of the recoiled pigtail. During rotation, the pigtail is slowly advanced and withdrawn over the stationary guide wire within the embolic occlusion. Top: pigtail rotation catheter (5F) with the wire leaving the oval side hole (long arrow). Tip of the 5.5F sheath (short arrow). Bottom: proximal end of the catheter system: a rough shrink tube allows bimanual rotation of the catheter shaft. Hemostasis valve of the sheath (arrow) with side port for flushing.
CHEST  , DOI: ( /chest )
Copyright © 1998 The American College of Chest Physicians Terms and Conditions

3. FIGURE 2
A .36-year-old male patient with traumatic fractures of the first cervical vertebra, right upper and lower leg, and thrombosis of the right femoral vein. Top left: Prefragmentation complete occlusion of the left pulmonary artery. Top right: pigtail rotation catheter in place, from left femoral approach (right femoral thrombi, jugular approach not possible, because patient was wearing a “stiff-neck” bandage). Bottom left: after embolus fragmentation: partial recanalization and intraluminal fragments (arrows). Bottom right: final control angiography 3 days later (central venous digital subtraction angiography) after additional thrombolysis with 70 mg of plasminogen activator.
CHEST  , DOI: ( /chest )
Copyright © 1998 The American College of Chest Physicians Terms and Conditions

4. FIGURE 3
Ineffective fragmentation in a 53-year-old male patient with traumatic lumbar spine fractures. There is an obvious mismatch in size between the small pigtail and the enlarged pulmonary artery containing a large, high consistent embolus. In this patient with proven heparin-induced thrombocytopenia, a thrombolysis with 60 mg of plasminogen activator already had been performed the day before without any recanalization effect. Left: pigtail rotation catheter in the right main artery via jugular access (same scale as the right panel). Right: postcatheter treatment, only marginal improvement of perfusion: there is still a large embolus (arrowheads) in an enlarged right main pulmonary artery, with narrow bands of circumferential flow.
CHEST  , DOI: ( /chest )
Copyright © 1998 The American College of Chest Physicians Terms and Conditions