Key result
Mechanical thrombectomy using the FlowTriever system achieved a 100% technical success rate and 77.8% clinical success rate, significantly reducing mean main pulmonary artery pressure in patients with concurrent patent foramen ovale and acute pulmonary embolism.
Why the study?
The current level of evidence for mechanical thrombectomy of pulmonary embolism in patients with patent foramen ovale is limited.
Does mechanical thrombectomy improve pulmonary artery pressure and clinical outcomes in patients with acute pulmonary embolism and concurrent patent foramen ovale?
Observational (n=9)
Yes
Does mechanical thrombectomy improve pulmonary artery pressure and clinical outcomes in patients with acute pulmonary embolism and concurrent patent foramen ovale?
Mechanical thrombectomy using the FlowTriever system appears feasible and effectively reduces pulmonary artery pressure in patients with acute pulmonary embolism and concurrent patent foramen ovale, though the risk of paradoxical embolism requires careful consideration.
Feasibility of MT in PE with PFO suggested by small series; leaves open need for prospective trials before practice change.
BACKGROUND: The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited. RESULTS: This was a retrospective analysis of 9 patients with PFO and acute high-risk or intermediate-high-risk PE, 6 with intermediate-high risk and 3 with high-risk PE. All underwent MT using the Inari FlowTriever System from Dec 2018 to November 2019. Six of these patients had confirmed deep venous thrombosis. The technical and clinical success rate for MT in all patients was 100% and 77.8%, respectively. Right-heart strain improved in 6/8 patients on follow-up echocardiography. Mean main pulmonary artery (MPA) pressure significantly decreased after MT (p < 0.012). One patient presented with altered mental status (somnolence and disorientation) prior to coronary artery angiogram and thrombectomy, developed a middle cerebral artery embolic stroke 1 day after MT, and recovered with minor sequalae and later was discharged. There was no in-hospital mortality. CONCLUSIONS: MT using FlowTriever was feasible and safe, successfully improving MPA pressure in patients presenting with concurrent PFO and PE.
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Nezami et al. (2020) conducted an observational in Acute pulmonary embolism with concurrent patent foramen ovale (n=9). Mechanical thrombectomy using the Inari FlowTriever System was evaluated on Clinical success (stabilization of hemodynamics, improved O2 saturation, improvement in pulmonary hypertension, resolution of right heart strain, and survival to discharge). Mechanical thrombectomy using the FlowTriever system achieved a 100% technical success rate and 77.8% clinical success rate, significantly reducing mean main pulmonary artery pressure in patients with concurrent patent foramen ovale and acute pulmonary embolism.
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