Mechanical Thrombectomy and Catheter-Directed Lysis in Treating Intermediate-Risk Pulmonary Embolization: 30-Day Outcome

Abstract

Background

Intermediate risk pulmonary embolism (IRPE) is defined as dilatation of the right ventricular (RV) and evidence of myocardial necrosis with stable hemodynamics in the setting of acute PE. The differences in performance among the various devices in treating IRPE remain unclear.

Materials and Methods

We reviewed consecutive patients treated at 2 medical centers between January 1, 2019, and December 31, 2022, using PMC devices (FlowTriever [Inari Medical] or Ekos [Boston Scientific]). Demographics, clinical, procedural variables, in-hospital complications, and 30-day outcomes were recorded from patients' medical records. Descriptive analyses were performed. The study's primary endpoint was the mean change in the RV/LV ratio. Safety endpoints included procedural complications 30-day mortality and major bleeding.

Results

97 consecutive patients (43 FlowTriever, 54 Ekos) were included. The mean age was 64.16 ± 13.37 years. When compared with pretreatment, PMC reduced significantly the RV/LV ratio (0.55 ± 0.49, 95% CI: 0.40, 0.71, p < 0.0001) and PA pressures (17.98 ± 14.72 mm Hg, 95% CI:10.88, 25.07, p < 0.0001) with no differences seen between the FlowTriever and Ekos. At 30-day, all-cause mortality and major bleeding were 5.2 and 7.2%, respectively, and were similar between the FlowTriever and Ekos, respectively (4.7% vs. 5.6% (p = 0.935) and 7.0% vs. 7.4% (p = 0.935)). The Ekos, however, had a shorter procedure time, and less fluoroscopy and contrast use.

Conclusion

PMC devices reduced significantly the RV/LV ratio and PA pressures when compared with the baseline. No differences were seen between the FlowTriever and Ekos. Thirty-day mortality and major bleeding were statistically similar between the two devices.

Keywords

intermediate-risk pulmonary embolus - ultrasound-assisted lysis - mechanical thrombectomy - major bleeding

Note

The abstract of this work was presented at the CRT 2024 Conference in Washington DC as an Oral presentation with interim findings. The abstract was published in JACC: Cardiovascular Interventions, Volume 17, Issue 4, Supplement, February 26, 2024, Pages S38–S39. https://doi.org/10.1016/j.jcin.2024.01.167

Publication History

Article published online:
02 May 2025

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