Comparative Pulmonary Artery Pressure Response between Large-Bore Thrombectomy and Catheter-Directed Thrombolysis in...

To compare pulmonary artery pressure (PAP) response and clinical outcomes between large-bore thrombectomy (LBT) and catheter-directed thrombolysis (CDT) in patients with intermediate-high- and high-risk pulmonary embolism (PE).

Consecutive patients treated with LBT and CDT with right atrial pressure and PAP were included. Fifty patients with complete hemodynamic assessment from the CDT group were matched to 80 LBT patients using 1:1 propensity score matching. Periprocedural adverse events were evaluated, and exploratory analyses correlated hemodynamics with a composite of PE-related death, nonfatal recurrent central PE, or chronic thromboembolic pulmonary hypertension (CTEPH) over 5 years. The primary outcome was the impact of hemodynamic parameters on PE-related outcomes over 5 years. The secondary outcome was between-group hemodynamic response and PE-related outcomes.

Across the matched cohort (n = 100), mean age was 59 years with mean body mass index of 34.7 kg/m². Higher initial and final PAPs were associated with greater odds of the composite PE-related outcome. Despite similar PAPs at baseline, LBT achieved greater hemodynamic response and lower periprocedural complication rate than CDT (all P < .05). Although numerical differences in all-cause mortality (LBT, 12%, vs CDT, 18%), PE-related mortality (LBT, 0%, vs CDT, 8%), CTEPH (LBT, 2.1%, vs CDT, 6.2%), and PE recurrences (LBT, 4.2%, vs CDT, 10.4%) were observed, the composite PE-related outcome did not differ significantly (P = .070).

Both initial and final PAPs were associated with subsequent PE adverse events, suggesting that catheter-based therapy is not the sole determinant of PE outcomes. LBT achieved greater hemodynamic unloading than CDT but outcomes did not differ meaningfully.