Catheter-directed thrombectomy for acute pulmonary embolism significantly reduced systolic pulmonary artery pressure from 64 to 38 mmHg (p<0.001) immediately post-procedure.
Does catheter-directed mechanical thrombectomy improve hemodynamic parameters in patients with acute intermediate/high-risk pulmonary embolism?
Catheter-directed mechanical thrombectomy significantly improves immediate and 48-hour hemodynamic and respiratory parameters in patients with acute intermediate/high-risk pulmonary embolism.
Abstract Introduction / Purpose Pulmonary embolism (PE) remains a major cause of cardiovascular mortality. In intermediate–high-risk PE, interventional management with catheter-directed mechanical thrombectomy is gaining ground due to increasing evidence of its efficacy and safety. Material and Methods We present our center’s experience with a catheter-directed thrombectomy program for patients with acute intermediate/high-risk PE between April 2023 and April 2025, focusing on the improvement of invasive and non-invasive hemodynamic parameters. A total of 28 patients underwent the procedure (60% female, 36% referred from another hospital, mean age 62 years). Results The most common symptom was dyspnea (70%), with a median time to seeking care of 12 hours (IQR 1 hour – 10 days). Risk stratification scores were: PESI 108 (IQR 73–227), Bova 5±1, and Shock Index 0.98±0.3. A precipitating factor was identified in 40%, most commonly limb trauma with or without surgery, and deep vein thrombosis was present in 36%. Four patients reported COVID-19 infection within the previous 6 months, and one had an active infection. Typical echocardiographic findings were present in most cases: D-shape in 100%, McConnell sign and early systolic notch in 92%, while 60/60 sign was observed in 56%. The echocardiographic RV/LV ratio was 1.2 ± 0.1. CTPA revealed filling defects in both main pulmonary artery branches in 24/25 patients, and saddle embolism in 24%. Pre-procedural hemodynamic and respiratory parameters were: · Systolic BP: 116 ± 13 mmHg · HR: 111 ± 5 bpm · PO2:FiO2: 268 ± 64 · sPAP: 64 ± 10 mmHg · Lactate: 1.5 ± 0.5 mmol/L Immediately post-procedure, significant improvements were observed: · Systolic BP: 133 ± 9 mmHg (t=3.022 24, p=0.013) · HR: 89 ± 8 bpm (t=5.505 24, p0.001) · PO2:FiO2: 325 ± 102 (t=2.322 24, p=0.043) · sPAP: 38 ± 9 mmHg (t=12.713 24, p0.001) · Lactate: 1 ± 0.3 mmol/L (t=4.415 24, p=0.001) At 48 hours, further improvement was seen: HR 78 ± 7 bpm, PO2:FiO2 ratio 397 ± 95, and lactate 0.8 ± 0.2 mmol/L. Cardiac output (Cardiac Index, CI) measured via arterial line (Vigileo©) showed: · Pre-procedure CI: 2.1 L/min/m² (IQR 1.3–2.4) · Immediately post-procedure: 2.7 L/min/m² · At 48 hours: 3.1 L/min/m² At 48 hours, the RV/LV ratio improved significantly to 0.99 ± 0.07 (p0.001) (t=7.662 24, p0.001). Patients were weaned off supplemental oxygen in 3 days (IQR 0–10), stayed in the cardiac ICU for 3 days (IQR 0–5), and had a total hospital stay of 6 days (IQR 4–11). Only one patient experienced a vascular complication, which was successfully managed. Conclusion Our initial experience in the hemodynamic laboratory with catheter-directed thrombectomy for patients with acute intermediate/high-risk PE aligns with published data regarding the safety and efficacy of the method when performed in experienced centers and in carefully selected patients.
Latsios et al. (2026) studied this question. Catheter-directed thrombectomy for acute pulmonary embolism significantly reduced systolic pulmonary artery pressure from 64 to 38 mmHg (p<0.001) immediately post-procedure.