Techniques and Devices for Catheter-Directed Therapy in Pulmonary Embolism

The clinical presentation of a patient with acute pulmonary embolism (PE) can be classified into 3 categories: low-risk, submassive (presence of right heart strain), and massive (hemodynamic compromise). Massive PE is associated with high morbidity or mortality and typically treated with systemic intravenous thrombolysis. Over the last 2 decades, however, catheter-directed techniques have become an increasingly popular treatment modality for patients with a contraindication to systemic thrombolysis or without clinical improvement after systemic thrombolysis. Furthermore, endovascular treatment for patients with submassive PE has been of great interest due to the significantly increased mortality associated with right heart strain, and prospective clinical trials have demonstrated catheter-directed thrombolysis to decrease right heart strain earlier than systemic anticoagulation alone. This article describes available devices and endovascular techniques used to treat patients with massive and submassive acute PE.