Outcomes With Hybrid Catheter-Directed Therapy Compared With Aspiration Thrombectomy for Patients With Intermediate-High Risk Pulmonary Embolism

Sylwia Sławek-Szmyt; Aleksander Araszkiewicz; Stanisław Jankiewicz; Marek Grygier; Tatiana Mularek-Kubzdela; Maciej Lesiak

doi:10.1007/s10557-024-07562-4

Outcomes With Hybrid Catheter-Directed Therapy Compared With Aspiration Thrombectomy for Patients With Intermediate-High Risk Pulmonary Embolism

Cardiovasc Drugs Ther. 2024 Apr 2. doi: 10.1007/s10557-024-07562-4. Online ahead of print.

Authors

Sylwia Sławek-Szmyt¹, Aleksander Araszkiewicz², Stanisław Jankiewicz², Marek Grygier², Tatiana Mularek-Kubzdela², Maciej Lesiak²

Affiliations

¹ First Department of Cardiology, Poznan University of Medical Sciences, Dluga Street 1/2, 61-848, Poznan, Poland. sylwia.slawek@usk.poznan.pl.
² First Department of Cardiology, Poznan University of Medical Sciences, Dluga Street 1/2, 61-848, Poznan, Poland.

PMID: 38564122
DOI: 10.1007/s10557-024-07562-4

Abstract

Purpose: Intermediate-high-risk pulmonary embolism (IHR PE) is a challenging form of embolism obstruction that causes right ventricular (RV) 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 complex catheter-directed therapy (CDT) - catheter-directed mechanical aspiration thrombectomy (CDMT) supplemented with catheter-directed thrombolysis (hybrid CDT) in comparison to CDMT alone for IHR PE.

Methods: A propensity score based on the 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, 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: NCT0447356-registration date 16 July 2020.

Trial registration: ClinicalTrials.gov NCT00447356.

Keywords: Catheter-directed mechanical thrombectomy; Catheter-directed thrombolysis; Pulmonary obstruction; Right ventricular dysfunction.

Associated data

ClinicalTrials.gov/NCT00447356