Pulmonary Embolism Treatment in Oklahoma City

Dr. Michael Megaly performing CTO PCI at Integris Health Heart Hospital, Oklahoma City

What Is a Pulmonary Embolism?

A pulmonary embolism occurs when a blood clot lodges in the arteries that carry blood from the right side of the heart to the lungs. Most clots form first in the deep veins of the legs or pelvis and break free. Once in the lungs, the clot obstructs blood flow, lowers oxygen levels, and forces the right ventricle to pump against high resistance.

The right ventricle is a thin-walled chamber that is not built to handle sudden pressure overload. When a large clot burden strains it, the right ventricle can dilate and fail. This sequence turns a PE from a lung problem into a heart problem, and it is the main driver of death from PE.

Symptoms and Risk Factors

Common symptoms include:

Sudden or worsening shortness of breath.
Chest pain that worsens with a deep breath.
Rapid heart rate.
Lightheadedness or fainting.
Coughing up blood.
Leg swelling or pain from an associated DVT.

Risk factors include:

Recent surgery, hospitalization, or prolonged immobility.
Cancer.
Prior DVT or PE.
Pregnancy or estrogen-containing medications.
Inherited or acquired clotting disorders.
Long-distance travel.

If you have sudden shortness of breath, chest pain, or fainting, call 911.

How Pulmonary Embolism Severity Is Assessed

Treatment begins with risk stratification. PE is generally classified into three groups:

High-risk (massive) PE: low blood pressure, shock, or cardiac arrest caused by the clot. This is a life-threatening emergency that requires immediate restoration of blood flow.
Intermediate-risk (submassive) PE: normal blood pressure, but evidence of right ventricular strain on CT or echocardiography and/or elevated cardiac biomarkers such as troponin. A subset of these patients is at risk of sudden deterioration.
Low-risk PE: normal blood pressure with no right heart strain. These patients are typically treated with anticoagulation alone, sometimes as outpatients.

The intermediate-risk group is where judgment matters most. Some patients stabilize on blood thinners alone, while others decline over the first 24 to 72 hours. Identifying which patients need advanced therapy, and when, is central to modern PE care.

Treatment Options for Pulmonary Embolism

Anticoagulation

Blood thinners prevent the clot from growing and new clots from forming while the body gradually breaks down the existing clot. Every patient with PE receives anticoagulation unless it is contraindicated.

Systemic Thrombolysis

Clot-dissolving medication given through an IV can rapidly reverse high-risk PE. It is given at full dose throughout the entire bloodstream; however, it carries a meaningful risk of major bleeding, including bleeding in the brain. Many patients with PE, such as those with recent surgery, older age, or prior bleeding, are poor candidates for it.

Catheter-Directed Therapy

Catheter-directed therapy treats the clot directly inside the pulmonary arteries. A catheter is advanced through a vein, usually in the groin or neck, under X-ray guidance. The main approaches are:

Mechanical thrombectomy: large-bore aspiration or extraction catheters physically remove clot from the pulmonary arteries. This can relieve right ventricular strain immediately and generally avoids clot-dissolving drugs, which makes it an option for patients at elevated bleeding risk.
Catheter-directed thrombolysis: a small catheter is placed within the clot and delivers a low dose of clot-dissolving medication over several hours, sometimes with ultrasound assistance. The dose is a fraction of the dose used in systemic thrombolysis.

Catheter-directed therapy is considered for high-risk PE and for intermediate-risk patients who are deteriorating or at high risk of deterioration. Randomized trial evidence comparing these approaches is evolving rapidly.

Mechanical Circulatory Support

In the sickest patients, those in shock or cardiac arrest from PE, temporary mechanical support may be required to keep blood and oxygen moving while the clot is treated. The main option is veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Selecting these patients and timing support correctly requires experience with both catheter-based therapy and advanced hemodynamic support.

Surgical Embolectomy and IVC Filters

Surgical removal of clot is an option at selected centers for certain high-risk patients.

Inferior vena cava (IVC) filters are reserved for specific situations, such as patients who cannot receive anticoagulation.

Computer assisted mechanical thromectomy for pulmonary embolism| Michael Megaly| Oklahoma city

Why a Coordinated Team Approach Matters

PE care involves emergency medicine, cardiology, pulmonary and critical care, interventional cardiology, and cardiac surgery. The best decisions come from these specialists evaluating the patient together and quickly. They weigh clot burden, right heart function, bleeding risk, and overall condition before choosing between anticoagulation alone, catheter-based therapy, or advanced support.

Integris Health Heart Hospital has a multidisciplinary Pulmonary Embolism Response Team (PERT) that brings these specialists together to evaluate patients with serious pulmonary embolism and agree on a treatment plan quickly. Dr. Michael Megaly is a member of the PERT and performs catheter-directed therapy when the team determines it is the right option.

Interventional cardiologists with training in cardiogenic shock and mechanical circulatory support bring a specific advantage to high-risk PE. Right ventricular failure from PE is a form of cardiogenic shock, and managing it draws on the same hemodynamic expertise.

Recovery and Follow-Up

Most patients continue anticoagulation for at least three months. Some need longer or indefinite treatment depending on the cause of the clot and their risk of recurrence.

Follow-up typically includes reassessment of symptoms and exercise tolerance. A minority of patients have persistent shortness of breath after PE. These patients should be evaluated for chronic thromboembolic disease, including chronic thromboembolic pulmonary hypertension (CTEPH), which has its own dedicated treatments.

Pulmonary clots after pulmonary thrombecotomy | Oklahoma city| Michael Megaly

Frequently Asked Questions About Pulmonary Embolism

Is pulmonary embolism an emergency?

Yes. PE can be fatal, particularly when it strains the right side of the heart. Anyone with sudden shortness of breath, chest pain, or fainting should seek emergency care immediately.

Does every pulmonary embolism need a procedure?

No. Most patients with PE are treated effectively with blood thinners alone. Catheter-based therapy is reserved for high-risk PE and for selected intermediate-risk patients with significant right heart strain or signs of deterioration.

What is a Pulmonary Embolism Response Team (PERT)?

A PERT is a multidisciplinary team of physicians, typically including interventional cardiology, pulmonary and critical care, emergency medicine, and cardiac surgery, who evaluate patients with serious pulmonary embolism together. The team reviews clot burden, right heart function, bleeding risk, and overall condition to choose between anticoagulation alone, catheter-directed therapy, or advanced support.

What is the difference between mechanical thrombectomy and thrombolysis?

Mechanical thrombectomy physically removes clot through a catheter and usually avoids clot-dissolving medication. Thrombolysis uses medication to dissolve the clot. It can be given systemically through an IV or at a low dose directly into the clot through a catheter. The choice depends on clot location, how unstable the patient is, and bleeding risk.

How long is recovery after catheter-directed therapy for PE?

Recovery depends mainly on how sick the patient was before treatment. Stable patients often go home within a few days. Patients who presented in shock may need longer hospitalization and intensive care.

Can a pulmonary embolism come back?

Yes. The risk of recurrence depends on what caused the clot. This is why the duration of anticoagulation is individualized, and why the underlying cause should be evaluated.

What happens if I am still short of breath months after a PE?

Persistent symptoms after at least three months of anticoagulation should be evaluated. Testing typically includes echocardiography and, when indicated, ventilation-perfusion imaging to look for chronic thromboembolic disease.

Who performs catheter-based pulmonary embolism treatment in Oklahoma City?

Dr. Michael Megaly performs catheter-directed pulmonary embolism therapy, including mechanical thrombectomy and catheter-directed thrombolysis, at Integris Health Heart Hospital in Oklahoma City, where he is a member of the multidisciplinary Pulmonary Embolism Response Team (PERT).

Pulmonary Embolism at a Glance

A pulmonary embolism (PE) is a blood clot that travels to the lungs and blocks one or more pulmonary arteries, most often originating from a deep vein thrombosis (DVT) in the legs.
PE is the third most common cause of cardiovascular death in the United States, after heart attack and stroke.
Severity ranges from low-risk clots treated with blood thinners alone to high-risk PE causing right heart failure, shock, or cardiac arrest.
Blood thinners (anticoagulation) are the foundation of treatment for every patient with PE.
For selected higher-risk patients, catheter-based therapy can remove or dissolve the clot through a vein in the leg or neck, without open surgery.
Treatment decisions depend on blood pressure, right heart strain on imaging, cardiac biomarkers, and bleeding risk.

Medically reviewed by Michael Megaly, MD, MS, FACC, FSCAI; Interventional Cardiologist, Integris Health Heart Hospital, Oklahoma City.

Dr. Michael Megaly performs catheter-directed therapy for pulmonary embolism, including mechanical thrombectomy and catheter-directed thrombolysis, at Integris Health Heart Hospital in Oklahoma City, where he is a member of the multidisciplinary Pulmonary Embolism Response Team (PERT). He completed an advanced fellowship in complex high-risk coronary intervention and advanced hemodynamic support at Henry Ford Hospital in Detroit, and has co-authored nationwide studies on the treatment and outcomes of high-risk pulmonary embolism published in the European Heart Journal: Acute Cardiovascular Care and Mayo Clinic Proceedings.