Outcomes of catheter intervention for acute pulmonary emboli in a tertiary United Kingdom centre with an established Pulmonary Embolism Response Team (PERT)

OBJECTIVE: Determine the outcome of patients treated with catheter-directed interventions as per published recommendations for management escalation by the Pulmonary Embolism Response Team (PERT) Consortium. DESIGN: Retrospective, observational cohort study. MATERIALS AND METHODS: Retrospective review of patient records managed with catheter-directed intervention between April 2012 and March 2022. Risk stratification was performed as per European Society of Cardiology (ESC) guidelines. Patient demographics, clinical status, and imaging on presentation, procedural details, and outcomes with a minimum follow-up period of 1 year were analysed. RESULTS: Seventy-nine cases were performed in 76 patients (n = 76; mean age 52 years, range 7-86; male:female = 37:39). Fifty-four patients were high-risk, 16 intermediate-high and 7 intermediate-low risk (n = 77 cases). 39% of high-risk and 22% of intermediate-risk cases had an absolute or relative contraindication to thrombolytic therapy. Seventeen percent of high-risk and 4% of intermediate-risk cases had a failed trial of systemic thrombolysis. 54% of high-risk and 78% of intermediate-risk cases had a failed trial of anticoagulation. There was a statistically significant reduction in the RV:LV ratio (p = 0.05) and clot burden (p < 0.0001) following catheter intervention. Available echocardiographic data demonstrated a trend towards improving right heart strain. Bleeding events occurred in 18% of cases, with 79% being high-risk. There was a significant improvement in functional outcomes as per WHO functional status (p < 0.001). CONCLUSION: Catheter-directed thrombolysis under the guidance of a PERT is a safe and effective therapy and provides a valuable management option for patients who have a contraindication to systemic thrombolysis or have failed a trial of systemic therapy.