[Interventional therapy of pulmonary embolism - update]

Area of Science:

• Cardiology
• Interventional Radiology
• Pulmonary Medicine

Background:

• Pulmonary embolism (PE) management has evolved with new catheter-based interventions.
• Traditional systemic thrombolysis has limitations and low evidence for high-risk PE.
• Interventional therapies aim for improved thrombus removal and right heart function restoration.

Purpose of the Study:

• To review current catheter-based systems for pulmonary embolism recanalization.
• To compare the efficacy and safety of interventional therapies versus systemic thrombolysis.
• To highlight the emerging need for specialized pulmonary embolism response teams (PERT-teams).

Main Methods:

• Overview of catheter-based systems: EKOS, FlowTriever, and Indigo aspiration system.
• Analysis of preliminary data from registries and observational studies.
• Mention of ongoing randomized controlled trials comparing interventions to systemic thrombolysis.

Main Results:

• Catheter-based systems demonstrate safety and efficacy in thrombus removal.
• Interventional strategies show potential for greater effectiveness and reduced bleeding compared to systemic thrombolysis.
• Preliminary data are promising, but robust evidence from randomized trials is pending (results expected 2025).

Conclusions:

• Interventional recanalization offers a promising alternative for high- and intermediate-high risk PE.
• The complexity of PE management necessitates specialized interdisciplinary PERT-teams and structured approaches.
• Further evidence from ongoing clinical trials is crucial for definitive treatment guidelines.