Outcomes with hybrid catheter-directed therapy compared with aspiration thrombectomy for patients with intermediate-high risk pulmonary embolism

Abstract

Abstract Purpose Intermediate-high-risk pulmonary embolism (IHR PE) is a challenging form of embolism obstruction that causes right ventricular dysfunction. The optimal management of IHR PE has not been established. This single-center prospective, observational study aimed to evaluate the efficacy and safety of hybrid therapy (CDT)- catheter-directed mechanical aspiration thrombectomy (CDMT) in comparison to CDMT supplemented with catheter-directed thrombolysis (hybrid CDT) for IHR PE. Methods A propensity score based on Pulmonary Embolism Severity Index class and Miller Obstruction Index (MOI) was calculated, and 21 hybrid CDT cases (mean age 54.8 (14.7) years, 9/21 women) were matched with 21 CDMT cases (mean age 58.8 [14.9] years, 13/21 women). The baseline demographics and clinical and treatment characteristics were analyzed. Results No significant differences were detected regarding baseline demographics and PE severity parameters. Hybrid CDT demonstrated a higher reduction in mean pulmonary artery pressure (mPAP) (hybrid CDT: median mPAP reduction 8 mmHg [IQR: 6–10 mmHg] vs CDMT: median mPAP reduction 6 mmHg [IQR: 4–7 mmHg; P = 0.019), MOI score (hybrid CDT: median change − 5 points [IQR:5–6 points] vs CDMT median change − 3 points [IQR:3–5 points]; P = 0.019), and median RV: Left ventricular ratio (hybrid CDT: median change 0.4 [IQR:0.3–0.45] vs CDMT median change 0.26 [IQR:0.2–0.4]); P = 0.007). No major bleeding was observed. Both the hybrid CDT and CDMT alone treatments are safe and effective in managing IHR PE. Conclusions Hybrid CDT is a promising technique for the management of IHR PE with insufficient thrombus load reduction by CDMT. Trial registration number: NCT0447356 – registration date 16 July 2020