Catheter-directed thrombolysis and mechanical thrombectomy have largely replaced surgical pulmonary embolectomy and offer important alternatives to systemic thrombolysis for massive and submassive pulmonary embolism.
This review outlines the evolving landscape of pulmonary embolism management, highlighting the increasing role of catheter-directed therapies and mechanical thrombectomy for intermediate and high-risk patients.
Acute pulmonary embolism (PE) is a leading cause of morbidity and mortality worldwide. Systemic anticoagulation remains the recommended treatment for low-risk PE. Systemic thrombolysis is the recommended treatment for PE with hemodynamic compromise (massive/high-risk PE). A significant number of patients are not candidates for systemic thrombolysis due to the bleeding risk associated with thrombolytics. Historically, surgical pulmonary embolectomy (SPE) was recommended for massive PE with hemodynamic compromise for these patients. In the last decade, catheter-directed thrombolysis (CDT) has largely replaced SPE in the patient population with intermediate risk PE (submassive), defined as right heart strain (as evidenced by right ventricle enlargement on echocardiogram and/or computed tomography, usually along with elevation of troponin or B-type natriuretic peptide). Use of CDT increased in the last few years due to high incidence of PE in hospitalized patients with coronavirus disease 2019 pneumonia, and the use of mechanical thrombectomy (initially reserved for those with contraindications to thrombolysis) has also grown. In this article, we discuss the value of the PE response team, our approach to management of submassive (intermediate risk) and massive (high risk) PE with systemic thrombolytics, CDT, mechanical thrombectomy, and surgical embolectomy.
Kerrigan et al. (Thu,) conducted a review in Acute pulmonary embolism. Percutaneous management (catheter-directed thrombolysis and mechanical thrombectomy) vs. Systemic thrombolysis, surgical embolectomy, or standard anticoagulation was evaluated. Catheter-directed thrombolysis and mechanical thrombectomy have largely replaced surgical pulmonary embolectomy and offer important alternatives to systemic thrombolysis for massive and submassive pulmonary embolism.