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

Abstract

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.

Lightning 12 — an intelligent computer-assisted vacuum aspiration thrombectomy system in the treatment of pulmonary embolism: An initial experience

“…The mean (SD) RV to left ventricular (LV) ratio decreased from 1.36 (0.17) to 0.98 (0.16), (P <0.0001) and median (IQR) tricuspid annular plane systolic motion (TAPSE) increased from 14 (11)(12)(13)(14)(15)(16)) mm to 19 (17-22) mm (P <0.0001). NT-proBNP, troponin I, and lactate concentrations also significantly reduced quickly after the procedure (Supplementary material, Table S3).…”

“…Moreover, the 12F catheter's flexibility advantageously improves maneuvers within tortuous vessels and enlarged right heart ventricles. A larger diameter, improved catheter design, and an intelligent control unit allow for the more adequate removal of thrombi from both pulmonary arteries without increasing periprocedural blood loss compared to the previous generation of the device (Indigo CAT8 device) [5,[9][10][11]. Using larger-bore catheters and sheaths seems feasible and effective.…”