Long-Term Outcomes After Catheter-Directed Thrombolysis or Mechanical Thrombectomy in Intermediate-High-Risk...

Catheter-directed thrombolysis (CDL) and mechanical thrombectomy (MT) are increasingly used for intermediate-high-risk pulmonary embolism (PE), yet comparative long-term outcomes remain uncertain. We aimed to compare the effectiveness and safety of CDL versus MT in real-world clinical practice. Using the multi-institutional TriNetX network, we identified adults with acute intermediate-high-risk PE treated with CDL or MT. One-to-one propensity score matching was performed across demographics, comorbidities, and laboratory variables. Outcomes were assessed up to 2 years post-index. The primary outcome was all-cause mortality, while secondary outcomes included hospitalization, major adverse cardiovascular events (MACE), pulmonary hypertension (PH), and bleeding. After matching, 1290 patients remained in each group with balanced baseline characteristics, with a median follow-up of approximately 1.5 years. Long-term mortality was similar between CDL and MT (3.1% vs. 3.5%; p = 0.061). MACE rates were comparable (5.2% vs. 4.6%; p = 0.933), with no significant difference in PH (3.0% vs. 3.24%; p = 0.352). CDL was associated with higher hospitalization rates (2.2% vs. 0.9%; p = 0.026), while bleeding events were low and similar between groups. In this large real-world cohort of patients with intermediate-high-risk PE, CDL and MT demonstrated broadly comparable long-term outcomes, suggesting no clear superiority of either strategy and supporting ongoing clinical equipoise. Ongoing randomized trials are needed to further inform optimal management.