Outcome of Patients Presenting With High-Risk Pulmonary Embolism Treated With Mechanical Thrombectomy: A Subgroup...

High-risk pulmonary embolism (PE), defined as PE causing hemodynamic instability, remains associated with high acute mortality and currently warrants acute treatment with systemic thrombolysis. Mechanical thrombectomy can be considered where thrombolysis is inappropriate, as an alternative, or in addition to, but more prospective data are needed. This analysis evaluates the safety, effectiveness, functional, and quality of life (QoL) outcomes in high-risk PE patients who were treated using mechanical thrombectomy with computer-assisted vacuum thrombectomy (CAVT) devices.

Among the first 595 patients enrolled in the prospective, international STRIKE-PE study, 48 were identified as having high-risk PE. Outcomes included change in right-to-left ventricular ratio from baseline to 48-hour follow-up, 48-hour composite major adverse events (MAE), additional safety end points, and 90-day changes in functional and QoL assessments.

Mean right-to-left ventricular ratio decreased from 1.50 ± 0.36 to 1.02 ± 0.18 (P < .001). One study-defined MAE (major bleeding) occurred. One all-cause mortality and 1 symptomatic PE recurrence occurred within 30 days. Borg scale at rest improved from baseline to discharge (P < .001) and discharge to 90 days (P = .045). Borg scale after 6-minute walk test, 6-minute walk test distance, EQ-5D-5L index value, EuroQoL Visual Analog Scale, and Pulmonary Embolism QoL score improved (all P < .001). New York Heart Association class returned to pre-PE baseline. Six patients received systemic thrombolysis (1 periprocedure and 5 postprocedure); majority of patients received none.

CAVT for high-risk PE was feasible and associated with a low incidence of MAE and a low 30-day mortality rate. CAVT treatment facilitated improvements in hemodynamic status and RV strain. Dyspnea, distance walked, functional status, and QoL significantly improved.