Percutaneous Large-Bore Pulmonary Thrombectomy with the FlowTriever Device: Initial Experience in Intermediate-High...

Area of Science:

• Cardiology
• Interventional Radiology
• Vascular Medicine

Background:

• Pulmonary embolism (PE) poses a significant risk, particularly in intermediate-high and high-risk cases.
• Effective treatment strategies for severe PE are crucial for improving patient outcomes.
• Mechanical thrombectomy (MT) offers a minimally invasive approach to PE management.

Purpose of the Study:

• To evaluate the outcomes of patients with intermediate-high and high-risk PE treated with transfemoral mechanical thrombectomy (MT).
• To assess the efficacy and safety of the Inari FlowTriever aspiration catheter system in PE patients.
• To analyze hemodynamic changes and clinical outcomes post-MT.

Main Methods:

• Retrospective cohort study of 27 PE patients treated with MT between April 2021 and November 2021.
• Risk stratification based on European Society of Cardiology (ESC) guidelines.
• Comparison of pre- and post-procedure clinical and hemodynamic characteristics; analysis of hospital stay duration and adverse events.

Main Results:

• Significant reduction in mean pulmonary artery pressures (35.9 to 26.1 mmHg, p=0.002) and heart rates (109.4 to 82.8 bpm, p<0.001) post-MT.
• 18 of 27 patients were classified as high-risk PE.
• Procedure-related complications included two deaths from cardiogenic shock and three from post-interventional complications; one patient required CPR due to clot displacement.

Conclusions:

• Large-bore MT using the Inari FlowTriever system is a feasible treatment option for high-risk PE patients.
• The procedure demonstrated an acceptable rate of procedure-related complications in this cohort.
• MT can lead to significant hemodynamic improvements in PE patients.