Catheder directed thrombectomy in pulmonary embolism: conservative vs interventional therapy

Introduction Risk stratification scores are critical for guiding therapeutic decisions in patients presenting with acute pulmonary embolism (PE). This study evaluated whether established PE risk scores are associated with cardiac index (CI) and hemodynamic improvement after treatment (ΔCI) in patients who did or did not undergo mechanical catheter-directed thrombectomy. Methods Patients presenting with acute PE were retrospectively divided into two groups based on whether they underwent intervention: thrombectomy (n=28) or conservative management (n=33). Baseline characteristics, risk scores (Wells, Geneva, PERC, Pompe C, Bova, Hestia, PESI, sPESI, Shock Index, and ESC Risk Stratification), and minimally invasive measurements of cardiac index (CI) at admission (ED) and at 48 hours were compared between groups. Statistical comparisons were performed using t-tests, and correlation analyses used Pearson’s correlation coefficients. Results Patients who underwent thrombectomy had significantly higher PERC (3.37 ± 0.96 vs. 2.75 ± 0.94, p=0.0406) and Bova (5.00 ± 1.49 vs. 3.62 ± 1.93, p=0.0118) scores. Strong negative correlations were found between baseline CI and both Bova (-0.700) and Pompe C (-0.694) scores, indicating that higher risk scores were associated with worse initial hemodynamic status. Moreover, the Bova score showed a strong positive correlation with ΔCI (0.589), suggesting that patients with higher clinical risk scores experienced greater hemodynamic improvement after thrombectomy. Conclusion Higher PE risk scores, particularly Bova and Pompe C, are clearly associated with lower cardiac output (normotensive shock) at presentation and greater subsequent improvement in cardiac function following thrombectomy. These scores may serve as valuable tools for identifying intermediate–high-risk PE patients who could benefit earlier and more substantially from aggressive therapeutic interventions such as thrombectomy.