Percutaneous treatment options and mechanical circulatory support offer promising alternatives to systemic thrombolysis for high-risk pulmonary embolism, though clinical data remain limited.
Percutaneous treatments and mechanical circulatory support offer emerging options for managing high-risk pulmonary embolism, potentially improving safety compared to systemic thrombolysis.
Acute pulmonary embolism (PE) leads to an abrupt increase in pulmonary vascular resistance and right ventricular afterload, and when significant enough, can result in hemodynamic instability. High-risk PE is a dire cardiovascular emergency and portends a poor prognosis. Traditional therapeutic options to rapidly reduce thrombus burden like systemic thrombolysis and surgical pulmonary endarterectomy have limitations, both with regards to appropriate candidates and efficacy, and have limited data demonstrating their benefit in high-risk PE. There are growing percutaneous treatment options for acute PE that include both localized thrombolysis and mechanical embolectomy. Data for such therapies with high-risk PE are currently limited. However, given the limitations, there is an opportunity to improve outcomes, with percutaneous treatments options offering new mechanisms for clot reduction with a possible improved safety profile compared with systemic thrombolysis. Additionally, mechanical circulatory support options allow for complementary treatment for patients with persistent instability, allowing for a bridge to more definitive treatment options. As more data develop, a shift toward a percutaneous approach with mechanical circulatory support may become a preferred option for the management of high-risk PE at tertiary care centers.
Carroll et al. (Wed,) conducted a review in High-risk pulmonary embolism. Percutaneous treatment options (localized thrombolysis and mechanical embolectomy) vs. Systemic thrombolysis and surgical pulmonary endarterectomy was evaluated. Percutaneous treatment options and mechanical circulatory support offer promising alternatives to systemic thrombolysis for high-risk pulmonary embolism, though clinical data remain limited.