Impact of mechanical pulmonary thrombectomy for intermediate-risk pulmonary embolism: Results from a prospective...

Patients with intermediate-risk pulmonary embolism (PE) have significant risk of hemodynamic decompensation. Mechanical pulmonary thrombectomy (MT) allows for rapid reperfusion with reduced bleeding risks compared to systemic thrombolysis. However, data comparing efficacy and safety of MT versus anticoagulation therapy (AC) alone for intermediate-risk PE has been lacking. The aim of this study was to compare clinical outcomes of additive MT versus AC alone in intermediate-risk PE.

Consecutive patients with acute intermediate-risk PE were recruited and managed according to the same protocol in six hospitals. Patients undergoing MT in addition to AC were compared to a historical cohort managed with AC alone before MT was available. Primary endpoint was all-cause mortality at 30-days, while secondary endpoints were length of stay (LOS), major bleeding and hemodynamic changes.

A total of 270 patients (50 % male, mean age 61.6 ± 16.2-years) were enrolled, of which 94 underwent MT and 176 received only AC. Immediate improvements in hemodynamics were seen after MT, comprising significantly reduced pulmonary arterial pressures (PASP) and RV/LV ratio, and increased tricuspid annular plane systolic excursion (TAPSE) and TAPSE/PASP ratio. MT patients had shorter total (5.5 [3-12.3] vs. 11 [7-23.5] days, p < 0.001) and intensive care unit LOS (2 [1, 2] vs. 4 [2-12] days, p < 0.001) compared to those receiving AC. MT patients had significantly lower odds of 30-days mortality (aOR 0.11, CI 0.012-0.91, p = 0.041). One MT patient experienced major procedural-related bleeding (1.1 %).

MT rapidly improved hemodynamics, shortened hospitalisation and lowered 30-day all-cause mortality in intermediate-risk PE with an excellent safety profile.