Aspirated thrombus weight and volume are not associated with improvements in hemodynamics after large-bore mechanical thrombectomy in pulmonary embolism

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute pulmonary embolism (n=48). Intervention: Aspirated thrombus weight and volume. Primary outcome: Acute changes in systolic pulmonary artery pressure (sPAP) (ρ volume = 0.06; ρ weight = 0.10, p=>0.05).

Felix Götzinger; Lucas Lauder; Patricia Pérez Navarro; Michael Kunz; Mathias Wagner; Mert Tokcan; Jasper Boeddinghaus; Gregor Leibundgut; Michael Böhm; Andreas Link; Bruno Scheller; Felix Mahfoud

doi:10.1007/s00392-026-02986-4

July 30, 2026Clinical Research in CardiologyOpen Access

Aspirated thrombus weight and volume are not associated with improvements in hemodynamics after large-bore mechanical thrombectomy in pulmonary embolism

View Full Paper

Ask AI

Bookmark

Share

Key result

Aspirated thrombus weight and volume during LBMT are not linked to acute sPAP or RV uncoupling.

ρ volume = 0.06; ρ weight = 0.10
P>0.05
n=48

Why the study?

The relationship between aspirated thrombus weight and volume with clinical and hemodynamic outcomes after large-bore mechanical thrombectomy for acute pulmonary embolism remains unclear.

Does large-bore mechanical thrombectomy improve hemodynamics proportionally to aspirated thrombus weight and volume in patients with acute intermediate- or high-risk pulmonary embolism?

Key Points

To determine whether the weight and volume of thrombus removed during large-bore mechanical thrombectomy correlate with acute and 3-month improvements in hemodynamics, cardiac function, and biomarkers.
Prospective, open-label, single-arm registry analyzing N=48 patients with intermediate-risk (n=41) or high-risk (n=7) acute pulmonary embolism who underwent thrombectomy with the FlowTriever system.
Quantified aspirated thrombus weight, volume, and histological composition.
Assessed invasive hemodynamics, echocardiographic indices, and circulating biomarkers immediately post-procedure, at hospital discharge, and at 3-month follow-up (n=30).
Aspirated thrombus volume and weight did not correlate with acute changes in systolic pulmonary artery pressure (ρ = 0.06 and ρ = 0.10), right ventricular uncoupling (ρ = 0.47 and ρ = 0.46), or RV/LV ratio (ρ = −0.02 and ρ = −0.005; all p > 0.05).

Study Design

Type

Observational (n=48)

Blinding

Open-label

Multicenter

No

Structured PICO

Does large-bore mechanical thrombectomy improve hemodynamics proportionally to aspirated thrombus weight and volume in patients with acute intermediate- or high-risk pulmonary embolism?

P

Population

48 patients aged 18 years and older with acute intermediate- or high-risk pulmonary embolism and right heart dysfunction undergoing large-bore mechanical thrombectomy, followed for 3 months.

E

Exposure

Large-bore mechanical thrombectomy (LBMT) using the FlowTriever system

O

Outcome

Association between aspirated thrombus weight and volume and acute and 3-month changes in invasive hemodynamics, echocardiographic parameters, and biomarkerssurrogate

Main Result

Effect estimate: ρ volume = 0.06; ρ weight = 0.10

p-value: p=>0.05

Aspirated thrombus weight and volume do not correlate with hemodynamic or echocardiographic improvements after large-bore mechanical thrombectomy for acute pulmonary embolism, suggesting other mechanisms like relief of vasoconstriction drive recovery.

Limitations

Single-center, open-label design limits findings to hypothesis-generating only
Exclusion of low-risk PE patients limits generalizability
Thrombus volume assessment using Archimedes' principle is inherently imprecise and residual thrombus could not be quantified
Modest sample size may have left the study underpowered to detect certain associations
Thrombus age was assessed based on only one part of the thrombus, potentially leading to misclassification
Pulmonary vascular resistance calculation was based on diastolic pulmonary artery pressure rather than pulmonary capillary wedge pressure
Single-center, open-label study (hypothesis-generating only)
Pathologic analyses of thrombi were based on one part of the thrombi and might not reflect the totality of the thrombus
Cellular differentiation and immunohistochemical analysis to determine thrombus age was not performed

Implication

No correlation between thrombus metrics and hemodynamic response after LBMT should not guide patient selection; leaves open clot composition and other mechanisms in PE.

Abstract

Background Large-bore mechanical thrombectomy (LBMT) is a catheter-directed therapy for acute pulmonary embolism (PE). The relationship between aspirated thrombus weight and volume with outcomes remains unclear. Aims The aim was to evaluate the impact of aspirated thrombus weight and volume on outcomes after LBMT. Methods This prospective, open-label, single-arm, single-center registry study included 48 patients undergoing LBMT using the FlowTriever system (Inari Medical/Stryker, Irvine, CA, USA). Thrombus weight and volume were quantified, and clot composition assessed. Associations between thrombus characteristics and clinical, invasive hemodynamics, echocardiographic parameters, and biomarkers were evaluated immediately after the procedure, at hospital discharge, and at 3-month follow-up. Results Thrombus material was available in 48 patients (31% women), of which 41 presented with intermediate-risk and 7 with high-risk PE. LBMT resulted in significant reductions in systolic pulmonary artery pressures (sPAP) intraprocedurally (− 12.8 ± 8.3 mmHg, p < 0.001), with a further invasively measured decrease through 3 months (− 9.6 ± 10.6 mmHg, p < 0.001). From baseline to discharge, right ventricular coupling improved (+ 0.24, p < 0.001) and right ventricle (RV)/left ventricle (LV) ratio decreased (− 0.23, p < 0.001). NT-proBNP and high-sensitivity cardiac troponin T declined significantly. Neither thrombus weight nor volume correlated with acute changes in sPAP ( ρ volume = 0.06; ρ weight = 0.10), RV-uncoupling ( ρ volume = 0.47; ρ weight = 0.46), and RV/LV ratio ( ρ volume = − 0.02; ρ weight = − 0.005) ( p for all > 0.05), nor with outcomes at 3 months. Conclusions Aspirated thrombus weight and volume were not associated with improvements after LBMT, suggesting that, beyond mechanical obstruction, additional mechanisms potentially including paracrine and endocrine effects of thrombus material may contribute to acute and chronic PE-related cardiopulmonary dysfunction. Graphical Abstract Abbreviations: PE – pulmonary embolism, LBMT – large bore mechanical thrombectomy, PVR - pulmonary vascular resistance, RV – right ventricular, TTE – transthoracic echocardiography, sPAP – systolic pulmonary artery pressure, IQR – interquartile range, BH – Benjamin Hochberg. Acknowledgment: Images partly created with AI

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Götzinger et al. (2026) conducted an observational in Acute pulmonary embolism (n=48). Aspirated thrombus weight and volume was evaluated on Acute changes in systolic pulmonary artery pressure (sPAP) (ρ volume = 0.06; ρ weight = 0.10, p=>0.05). Aspirated thrombus weight and volume were not significantly associated with acute changes in systolic pulmonary artery pressure, right ventricular uncoupling, or RV/LV ratio after large-bore mechanical thrombectomy.

synapsesocial.com/papers/6a6d9885e258b358b3c6c016 https://doi.org/10.1007/s00392-026-02986-4

View Full Paper

Ask AI

Bookmark

Share

Aspirated thrombus weight and volume are not associated with improvements in hemodynamics after large-bore mechanical thrombectomy in pulmonary embolism

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Aspirated thrombus weight and volume are not associated with improvements in hemodynamics after large-bore mechanical thrombectomy in pulmonary embolism

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading