Mechanical thrombectomy versus catheter directed thrombolysis in patients with pulmonary embolism: A multicenter experience

• Published in: Catheterization and cardiovascular interventions 2023-01, Vol.101 (1), p.140-146
• Main Authors: Inci, Errol K., Khandhar, Sameer, Toma, Catalin, Licitra, Giancarlo, Brown, Matthew J., Herzig, Matthew, Matthai, William, Palevsky, Harold, Schwartz, Arielle, Wight, John A., McDaniel, Michael, Kumar, Gautam, Devireddy, Chandan, Baumgartner, Scott, Bashline, Michael, Jaber, Wissam A.
• Format: Article
• Language: English
• Subjects: Blood transfusion; catheter directed thrombolysis; Catheters; Embolism; Fibrinolytic Agents - adverse effects; Hemodynamics; Hemorrhage - chemically induced; Hospital Mortality; Humans; Lysis; mechanical thrombectomy; Patients; percutaneous pulmonary artery intervention; pulmonary embolism; Pulmonary Embolism - drug therapy; Pulmonary Embolism - therapy; Pulmonary embolisms; Retrospective Studies; submassive pulmonary embolism; Thrombectomy - adverse effects; Thrombectomy - methods; Thrombolysis; Thrombolytic Therapy - methods; tissue plasminogen activator; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30505

Objectives Compare in‐hospital outcomes of patients treated with either mechanical thrombectomy (MT) or catheter directed lysis (CDL) in treatment of acute pulmonary embolism (PE). Methods This is a multicenter, retrospective cohort study of patients undergoing MT or CDL for acute PE between 2014 and 2021. The primary outcome was the composite of in‐hospital death, significant bleed, vascular complication, or need for mechanical support post‐procedure. Secondary outcomes included the individual components of the composite outcome in addition to blood transfusions, invasive hemodynamics, echocardiographic data, and intensive care unit (ICU) utilization. Results 458 patients were treated for PE with 266 patients in the CDL arm and 192 patients in the MT arm. The primary composite endpoint was not significantly different between the two groups with CDL 12% versus MT 11% (p = 0.5). There was a significant difference in total length of ICU time required with more in the CDL group versus MT (3.8 ± 2.0 vs. 2.8 ± 3.0 days, p = 0.009). All other secondary end points showed no significant difference between the groups. Conclusions In patients undergoing catheter directed treatment of PE, there was no difference between MT and CDL in terms of in‐hospital mortality, bleeds, catheter‐related complications, and hemodynamics.