Comparison of Large-Bore Thrombectomy With Catheter-Directed Thrombolysis for the Treatment of Pulmonary Embolism

Feroze, Rafey; Arora, Shilpkumar; Tashtish, Nour; Dong, Tony; Jaswaney, Rahul; Castro‐Dominguez, Yulanka; Hammad, Tarek A.; Osman, Mohammad Najeeb; Carman, Teresa L.; Schilz, Robert; Shishehbor, Mehdi H.; Li, Jun

doi:10.1016/j.jscai.2022.100453

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…In an exploratory analysis, patients who died during follow-up had higher PESI scores, lower systolic blood pressures, and higher lactic acid levels than patients who survived. 16 In this study, thrombectomy reduced the primary outcome of RV/ LV ratio more than USAT. There was no difference between groups for the reduction in sPAP and the improvement in TAPSE/sPAP ratio, a measure of RV-arterial coupling.…”

Section: Discussionmentioning

confidence: 59%

“…Vascular complications, including aneurysms and arteriovenous fistulas, were rare (6% in the USAT group vs. 4% in the mechanical thrombectomy group). Similarly, in the retrospective study by Feroze and colleagues, there was no difference in bleeding outcomes between LBT and USAT 16 . This is particularly reassuring given the fact that mechanical thrombectomy requires large bore venous access (i.e., 16, 20, or 24‐F) in anticoagulated patients.…”

Section: Discussionmentioning

confidence: 76%

“…A recent retrospective cohort study comparing LBT and USAT in 147 patients presenting with acute intermediate‐high or high‐risk PE and using propensity matching to adjust for confounders did not find a difference in the primary outcome, all‐cause mortality (LBT 15.8% vs. 9.1%; hazard ratio 0.64; 95% CI: 0.21–1.98; p = 0.442). In an exploratory analysis, patients who died during follow‐up had higher PESI scores, lower systolic blood pressures, and higher lactic acid levels than patients who survived 16 …”

Section: Discussionmentioning

confidence: 98%

“…Similarly, in the retrospective study by Feroze and colleagues, there was no difference in bleeding outcomes between LBT and USAT. 16 This is particularly reassuring given the fact that mechanical thrombectomy requires large bore venous access (i.e., 16, 20, or 24-F) in anticoagulated patients. Of note, the participating site were well trained and experienced with both procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The LBT system (Inari Medical) used for LBT is a mechanical aspiration system aiming to aspirate large burden of central thrombus with a 60 mL syringe. Three aspiration catheters in different sizes are available (16,20,and 24 French). The system also comes with three self-expanding discs of nitinol; the small can accommodate small vessels <10 mm, the medium vessels between 10 and 14 mm, and the large vessels with a diameter of 15-18 mm.…”

Section: Methodsmentioning

confidence: 99%

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Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

Al‐Terki,

Lauder,

Mügge

et al. 2024

Cathet Cardio Intervent

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BackgroundUltrasound‐assisted thrombolysis (USAT) and large‐bore‐thrombectomy (LBT) are under investigation for the treatment of intermediate‐high and high‐risk pulmonary embolisms (PE). Comparative studies investigating both devices are scarce.AimsThis study aimed to compare the safety and efficacy of the two most frequently used devices for treatment of acute PE.MethodsThis multicenter, retrospective study included 125 patients undergoing LBT or USAT for intermediate‐ or high‐risk PE between 2019 and 2023. Nearest neighbor propensity matching with logistic regression was used to achieve balance on potential confounders. The primary outcome was the change in the right to left ventricular (RV/LV) ratio between baseline and 24 h.ResultsA total of 125 patients were included. After propensity score matching, 95 patients remained in the sample, of which 69 (73%) underwent USAT and 26 (27%) LBT. The RV/LV ratio decrease between baseline and 24 h was greater in the LBT than in the USAT group (adjusted between‐group difference: −0.10, 95% CI: −0.16 to −0.04; p = 0.001). Both procedures were safe and adverse events occurred rarely (10% following USAT vs. 4% following LBT; p = 0.439).ConclusionIn acute intermediate‐high and high‐risk PE, both LBT and USAT were feasible and safe. The reduction in RV/LV ratio was greater following LBT than USAT. Further randomized controlled trials are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

Al‐Terki,

Lauder,

Mügge

et al. 2024

Cathet Cardio Intervent

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

Sławek-Szmyt,

Araszkiewicz,

Jankiewicz

et al. 2024

Cardiovasc Drugs Ther

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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 e cacy 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. MethodsA 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. ResultsNo signi cant 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. ConclusionsHybrid CDT is a promising technique for the management of IHR PE with insu cient thrombus load reduction by CDMT.

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Catheter-directed thrombolysis versus thrombectomy for submassive and massive pulmonary embolism: A systematic review and meta-analysis

Ismayl,

Hamadi

et al. 2024

Cardiovascular Revascularization Medicine

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Comparison of Large-Bore Thrombectomy With Catheter-Directed Thrombolysis for the Treatment of Pulmonary Embolism

Cited by 4 publications

References 24 publications

Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

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

Catheter-directed thrombolysis versus thrombectomy for submassive and massive pulmonary embolism: A systematic review and meta-analysis

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