Outcomes of mechanical thrombectomy using the FlowTriever system for acute pulmonary embolism in Sweden-a national...

Reperfusion by mechanical thrombectomy (MT) is an alternative for reperfusion in acute pulmonary embolism (PE) when systemic thrombolysis (ST) is contraindicated or has failed.

This study evaluated the early experience from MT in Sweden with comparison with that of ST.

We included all adult patients treated with large-bore MT in Sweden from January of the year the technique was introduced until December 2023, as well as patients concurrently treated with ST in the respective hospitals. The primary outcome was a composite of early death or severe bleeding.

During the study period, MT was performed exclusively with the FlowTriever (FT) system. Among 132 patients included in 7 hospitals, 61 patients aged 67 ± 15 years were treated with FT only and 61 aged 68 ± 14 years with ST only. High-risk PE was present in 32 patients in the FT group and 38 in the ST group. All other patients had intermediate high-risk PE. There were 6 primary outcome events in the FT group and 17 in the ST group (adjusted odds ratio [OR], 0.19; 95% CI, 0.05-0.69). Five (8%) patients in the FT group and 13 (21%) in the ST group died within 30 days (OR, 0.33; 95% CI, 0.11-0.99). One severe bleeding occurred after FT and 7 after ST (OR, 0.18; 95% CI, 0.03-1.10).

MT, using the FT system, in high-risk and intermediate high-risk PE was effective and possibly safer than reperfusion with ST.