Percutaneous Mechanical Thrombectomy for Acute Intermediate-High Risk Pulmonary Embolism: Initial 18-Month Experience...

Acute pulmonary embolism (PE) remains the third cardiovascular cause of death, with significant mortality rates even in the intermediate risk spectrum.

The aim of this prospective cohort study was to investigate outcomes of patients with intermediate-high risk PE, treated with percutaneous mechanical thrombectomy (PMT) using the FLowtriever sytem.

Twenty-five consecutive patients (mean age 62 ± 16 years) treated with PMT for intermediate-high risk PE over an 18-month period were included. These patients were referred to this treatment by our local PERT, on a semi-urgent basis, based on recent promising large population registry data. Clinical, echocardiographic, and invasive data before and after the procedure as well as procedure-related adverse events were documented.

After PMT, an immediate reduction was noticed in systolic pulmonary arterial pressure (sPAP) from 64 ± 10 to 38 ± 9 mmHg (p = 0.006) and heart rate from 111 ± 5 to 89 ± 8 bpm (p = 0.001). The cardiac index was statistically significantly increased from a baseline 2.1 L/min/m² (1.3-2.4) to a post-op value of 2.6 (2.2-3.7) L/min/m² and finally 3.1 (2.6-4) L/min/m² at 48 h (p = 0.007). Regarding right ventricular function, the 48 h echocardiographic assessment showed a significant reduction of the RV/LV ratio by 17.5% (p < 0.001). No serious complications or deaths occurred during hospitalization and at 6-month follow-up.

In our initial experience of treating intermediate-high-risk PE patients with the specially designed large-bore PMT system, we document a statistically significant improvement in all PE-related severity indices, in accordance with large cohort published data. Moreover, our procedure-related complication rate was very low.