Endovascular treatment of pulmonary embolism: experience from a tertiary center
Key result
Endovascular treatment for high-risk PE is associated with a ~23% reduction in systolic pulmonary artery pressure.
- n=140
Why the study?
Intermediate-high and high-risk pulmonary embolism requires individualized reperfusion assessment, and endovascular techniques have emerged as therapeutic options to improve pulmonary perfusion and right ventricular function.
Does endovascular treatment improve hemodynamic parameters in patients with intermediate-high and high-risk pulmonary embolism?
Key Points
- To describe the experience of a tertiary center in managing pulmonary embolism using endovascular techniques and to assess hemodynamic outcomes.
- Retrospective analysis of 140 consecutive patients diagnosed with pulmonary embolism.
- Clinical, echocardiographic, hemodynamic, and procedural variables were collected before and after treatment.
- Endovascular techniques included mechanical thrombectomy, thromboaspiration, and thrombolysis.
- Systolic pulmonary artery pressure decreased from 56.9 to 43.6 mmHg (p<0.001).
- Mean pulmonary pressure reduced from 35.9 to 27.2 mmHg (p<0.001).
- Cardiac output increased from 4.0 to 4.9 L/min (p<0.001), indicating hemodynamic improvement.
Study Design
Type
Observational (n=140)
Multicenter
No
Structured PICO
Does endovascular treatment improve hemodynamic parameters in patients with intermediate-high and high-risk pulmonary embolism?
P
Population
140 patients with intermediate-high (92%) and high-risk (8%) pulmonary embolism, mean age 61.5 years, 55% male.
I
Intervention
Endovascular treatment including mechanical thrombectomy, thromboaspiration, and/or local rTPA thrombolysis.
O
Outcome
Hemodynamic evolution (pulmonary artery pressure, right atrial pressure, and cardiac output) at 24 hours.surrogate
Endovascular treatment for intermediate-high and high-risk pulmonary embolism is safe and associated with early hemodynamic improvement.
Limitations
- Retrospective design
- Descriptive analysis without direct comparison between techniques
- Single-center experience
- Descriptive analysis without comparison between techniques
Implication
Endovascular treatment was associated with hemodynamic improvement in intermediate-high and high-risk PE; hypothesis-generating pending randomized outcome trials.
Abstract
Introduction Intermediate-high and high-risk pulmonary embolism (PE) requires individualized assessment to consider reperfusion strategies. Endovascular techniques—including mechanical thrombectomy, thromboaspiration, and local thrombolysis—have emerged as therapeutic options in experienced centers, aiming to improve pulmonary perfusion and right ventricular function. Objectives To describe the experience of a tertiary center in the endovascular management of PE, including clinical characteristics, techniques employed, and overall hemodynamic evolution. Methods A retrospective analysis was conducted of 140 consecutive patients diagnosed with PE between [years]. Clinical, echocardiographic, hemodynamic, and procedural variables were collected. Endovascular techniques were applied in selected patients: mechanical thrombectomy (n=29), thromboaspiration (n=12), and local rTPA thrombolysis (n=125). Hemodynamic parameters (pulmonary artery pressure, right atrial pressure, and cardiac output) were measured before the procedure and at 24 hours. Results are presented descriptively without comparison between techniques. Results The mean age was 61.5 ± 14.5 years, with a predominance of men (55%) (Table 1). Ninety-two percent of patients were classified as intermediate-high risk and 8% as high risk. The most frequent comorbidities were hypertension (54.3%), diabetes mellitus (17.9%), and active malignancy (12.1%). Echocardiographically, 91.4% presented a right-to-left ventricular ratio (RV/LV) > 1, and 33.6% showed McConnell’s sign. Among 106 patients with available PESI score, the median class was II. Norepinephrine was required in 8.6% and invasive mechanical ventilation in 3.3%. The most frequently used technique was local thrombolysis (89.3%), followed by mechanical thrombectomy (20.7%) and thromboaspiration (8.6%). The mean time from diagnosis to procedure was 24.6 hours (median 8 hours), with a mean procedure duration of 50.7 minutes and a mean contrast volume of 64 mL. Global hemodynamic analysis showed a reduction in systolic pulmonary artery pressure (from 56.9 to 43.6 mmHg) and mean pulmonary pressure (from 35.9 to 27.2 mmHg). Cardiac output increased overall (from 4.0 to 4.9 L/min) (Figure 1). No major procedure-related complications were recorded. Conclusions In this cohort of patients with high-risk PE, endovascular treatment was applied safely and was associated with early hemodynamic improvement. This descriptive analysis reflects the experience of a tertiary center with multiple available techniques. Further studies are warranted to directly compare the efficacy among different endovascular approaches.
EHJ Acute CV Care · cohort. In intermediate-high and high-risk PE, endovascular treatment linked to better hemodynamics Endovascular treatment of pulmonary embolism: experience from a tertiary center 140 patients: Intermediate-high and high-risk PE at one center. Endovascular reperfusion, reassessed at 24 hours: Mechanical thrombectomy → Thromboaspiration → Local rTPA thrombolysis → Hemodynamics at 24 hours. ~23% lower systolic pulmonary pressure. Linked to drop from 56.9 to 43.6 mmHg. 4.9 L/min: Cardiac output rose from 4.0 by 24 hours. Bottom line: Linked to hemodynamic improvement; randomized outcome trials still needed.
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Cite This Study
Guia et al. (2026) conducted an observational in Pulmonary embolism (intermediate-high and high-risk) (n=140). Endovascular treatment (mechanical thrombectomy, thromboaspiration, local thrombolysis) was evaluated on Hemodynamic parameters (pulmonary artery pressure, right atrial pressure, and cardiac output) at 24 hours. Endovascular treatment for high-risk pulmonary embolism safely reduced systolic pulmonary artery pressure from 56.9 to 43.6 mmHg and increased cardiac output from 4.0 to 4.9 L/min.