Hemodynamic improvement in pulmonary embolism after catheter-directed thrombectomy

Abstract Introduction / Purpose Pulmonary embolism (PE) remains a major cause of cardiovascular mortality. In intermediate–high-risk PE, interventional management with catheter-directed mechanical thrombectomy is gaining ground due to increasing evidence of its efficacy and safety. Material and Methods We present our center’s experience with a catheter-directed thrombectomy program for patients with acute intermediate/high-risk PE between April 2023 and April 2025, focusing on the improvement of invasive and non-invasive hemodynamic parameters. A total of 28 patients underwent the procedure (60% female, 36% referred from another hospital, mean age 62 years). Results The most common symptom was dyspnea (70%), with a median time to seeking care of 12 hours (IQR 1 hour – 10 days). Risk stratification scores were: PESI 108 (IQR 73–227), Bova 5±1, and Shock Index 0.98±0.3. A precipitating factor was identified in 40%, most commonly limb trauma with or without surgery, and deep vein thrombosis was present in 36%. Four patients reported COVID-19 infection within the previous 6 months, and one had an active infection. Typical echocardiographic findings were present in most cases: D-shape in 100%, McConnell sign and early systolic notch in 92%, while 60/60 sign was observed in 56%. The echocardiographic RV/LV ratio was 1.2 ± 0.1. CTPA revealed filling defects in both main pulmonary artery branches in 24/25 patients, and saddle embolism in 24%. Pre-procedural hemodynamic and respiratory parameters were: · Systolic BP: 116 ± 13 mmHg · HR: 111 ± 5 bpm · PO2:FiO2: 268 ± 64 · sPAP: 64 ± 10 mmHg · Lactate: 1.5 ± 0.5 mmol/L Immediately post-procedure, significant improvements were observed: · Systolic BP: 133 ± 9 mmHg (t=3.022 24, p=0.013) · HR: 89 ± 8 bpm (t=5.505 24, p0.001) · PO2:FiO2: 325 ± 102 (t=2.322 24, p=0.043) · sPAP: 38 ± 9 mmHg (t=12.713 24, p0.001) · Lactate: 1 ± 0.3 mmol/L (t=4.415 24, p=0.001) At 48 hours, further improvement was seen: HR 78 ± 7 bpm, PO2:FiO2 ratio 397 ± 95, and lactate 0.8 ± 0.2 mmol/L. Cardiac output (Cardiac Index, CI) measured via arterial line (Vigileo©) showed: · Pre-procedure CI: 2.1 L/min/m² (IQR 1.3–2.4) · Immediately post-procedure: 2.7 L/min/m² · At 48 hours: 3.1 L/min/m² At 48 hours, the RV/LV ratio improved significantly to 0.99 ± 0.07 (p0.001) (t=7.662 24, p0.001). Patients were weaned off supplemental oxygen in 3 days (IQR 0–10), stayed in the cardiac ICU for 3 days (IQR 0–5), and had a total hospital stay of 6 days (IQR 4–11). Only one patient experienced a vascular complication, which was successfully managed. Conclusion Our initial experience in the hemodynamic laboratory with catheter-directed thrombectomy for patients with acute intermediate/high-risk PE aligns with published data regarding the safety and efficacy of the method when performed in experienced centers and in carefully selected patients.