Abstract No. 176 Single-Center Evaluation of Large-Bore Suction Thrombectomy and Catheter-Directed Thrombolysis in the Treatment of Pulmonary Embolism: A Look at Mortality Outcomes

Endovascular therapies have gained significant adoption in the management of intermediate- and high-risk acute pulmonary embolism (PE). Still, despite substantial morbidity and mortality associated with PE, there is a paucity of literature comparing outcomes with large-bore suction thrombectomy (LBST) and catheter-directed thrombolysis (CDT). The purpose of this study is to evaluate the performance of LBST versus CDT within a single institution, with a particular focus on mortality outcomes. A single-center retrospective cohort study was performed. Patients admitted for acute PE who underwent treatment with LBST or CDT from 2019-2022 were included. LBST devices included FlowTriever (Inari Medical, Irvine, California) or Indigo Aspiration System (Penumbra, Alameda, California). CDT devices included EKOS Endovascular System (Boston Scientific, Boston, Massachusetts) or Uni-Fuse Infusion Catheter (AngioDynamics, Latham, New York). Chart review was performed to identify patient variables of interest and the primary endpoint of in-hospital mortality. Descriptive statistical analysis and Fisher's exact test for mortality outcomes was done, with propensity-score matching based on comorbidities to be performed. A total of 189 cases were identified, with 45.5% of patients treated with LBST (n=86, 55.8% female) and 54.5% treated with CDT (n=103, 49.5% female). Mean age of patients in the LBST and CDT groups was 67.6 ± 14.5 and 60.2 ± 15.0, respectively. Mean procedural time was recorded as 118.3 ± 50.3 minutes in LBST cases and 80.0 ± 38.1 minutes in CDT cases. In-hospital mortality in patients receiving LBST was 7.0% (6/86) compared to 2.9% (3/103) in those receiving CDT (ARD=0.041, p=0.3049). LBST and CDT are associated with similar rates of in-hospital mortality prior to matching. Both interventions are acceptable treatment strategies for intermediate- and high-risk acute PE, with LBST playing an important role in patients with contraindication to thrombolytics.