Catheter-directed mechanical aspiration thrombectomy in a real-world pulmonary embolism population: a multicenter registry

Author:

Sławek-Szmyt Sylwia1ORCID,Stępniewski Jakub23,Kurzyna Marcin4,Kuliczkowski Wiktor5,Jankiewicz Stanisław1,Kopeć Grzegorz2,Darocha Szymon4,Mroczek Ewa5,Pietrasik Arkadiusz6,Grygier Marek1,Lesiak Maciej1ORCID,Araszkiewicz Aleksander1ORCID

Affiliation:

1. Department of Cardiology, Poznan University of Medical Sciences , Długa 1/2 Street, 61-848 Poznan , Poland

2. Pulmonary Circulation Centre, Department of Cardiac and Vascular Disease, Jagiellonian University Medical College, John Paul II Hospital in Krakow, Prądnicka 80 Street, 31-202 Krakow, Poland

3. Department of Medical Education, Jagiellonian University Medical College , Medyczna 7 Street, 30-688 Krakow , Poland

4. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology European Health Centre Otwock, Medical Centre for Postgraduate Education , Borowa 14/18 Street, 05-400 Otwock , Poland

5. Department of Cardiology, Wroclaw Medical University , Borowska 213 Street, 50-556 Wroclaw , Poland

6. Department and Faculty of Cardiology, Medical University of Warsaw , Banacha 1A Street, 02-097 Warsaw , Poland

Abstract

Abstract Aims High- (HR) and intermediate-high risk (IHR) pulmonary embolisms (PEs) are related to high early mortality and long-term sequelae. We aimed to describe clinical outcomes and adverse events in IHR and HR pulmonary embolism (PE) treated with catheter-directed mechanical thrombectomy (CDMT) in a real-world population. Methods and Results This study is a multicenter, prospective registry enrolling 110 PE patients treated with CDMT between 2019 and 2022. The CDMT was performed using the 8F Indigo (Penumbra, Alameda, CA, USA) system bilaterally in pulmonary arteries (PAs). The primary safety endpoints included device or PE-related death during the 48-h after CDMT, procedure-related major bleeding, or other major adverse events. Secondary safety outcomes were all-cause mortality during hospitalization or the follow-up. The primary efficacy outcomes were the reduction of PA pressures and change in the right-to-left ventricular (RV/L) ratio assessed in the imaging 24–48 h after the CDMT. 71.8% of patients had IHR PE and 28.2% HR PE. 11.8% of patients had a failure and 34.5% had contraindications to thrombolysis, and 2.7% had polytrauma. There was 0.9% intraprocedural death related to RV failure and 5.5% deaths within the first 48 h. CDMT was complicated by major bleeding in 1.8%, pulmonary artery injury in 1.8%, and ischaemic stroke in 0.9%. Immediate haemodynamic improvements included a 10.4 ± 7.8 mmHg (19.7%) drop in systolic PAP (P < 0.0001), a 6.1 ± 4.2 mmHg (18.8%) drop in mean PAP, and 0.48 ± 0.4 (36%) drop in RV/LV ratio (P < 0.0001). Conclusion These observational findings suggest that CDMT may improve hemodynamics with an acceptable safety profile in patients with IHR and HR PE.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Critical Care and Intensive Care Medicine,General Medicine

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