Key result
Bolus thrombolysis plus manual aspiration thrombectomy shows no significant clinical benefit over conventional pulmonary embolism care.
Why the study?
Does catheter-directed bolus thrombolysis plus manual aspiration thrombectomy using conventional catheters improve clinical success in adults with intermediate-high- or high-risk acute pulmonary embolism compared to conventional management?
Cohort (n=23)
No
Does catheter-directed bolus thrombolysis plus manual aspiration thrombectomy using conventional catheters improve clinical success in adults with intermediate-high- or high-risk acute pulmonary embolism compared to conventional management?
Absolute Risk Reduction: 16.7 (95% CI -14.8–48.4)
Absolute Event Rate: 100% vs 83.3%
Absolute Risk Reduction: 16.7%
p-value: p=0.478
Bolus thrombolysis plus manual aspiration thrombectomy using conventional catheters is technically feasible and shows favorable early clinical outcomes for intermediate-high- and high-risk acute pulmonary embolism, though larger studies are needed to confirm efficacy.
Background: Dedicated pulmonary embolism (PE) thrombectomy devices are not universally available. We evaluated the early outcomes and safety of catheter-directed bolus thrombolysis plus manual aspiration thrombectomy (BT-MAT) using conventional catheters for intermediate-high- or high-risk acute PE. Methods: This retrospective, single-center, historical control study included adults with acute intermediate-high- or high-risk PE involving the main pulmonary artery. Patients who underwent BT-MAT from November 2023 to October 2025 were compared with historical controls who received conventional management such as anticoagulation or systemic thrombolysis before BT-MAT implementation (November 2022 to October 2023). BT-MAT comprised catheter-directed bolus alteplase injection followed by manual aspiration using conventional 7- to 8-Fr catheters or sheaths. Results: Twenty-three patients were included (BT-MAT, n = 11; historical control, n = 12). BT-MAT patients were younger (65.3 ± 16.5 vs. 78.2 ± 11.4 years; p = 0.040) and more frequently had bilateral main pulmonary artery involvement (82% vs. 33%; p = 0.036). Technical success was achieved in all BT-MAT procedures. Clinical success occurred in 11/11 BT-MAT patients and 10/12 conventional-treatment patients (100.0% vs. 83.3%; p = 0.478). No treatment-related complications occurred in the BT- MAT group, whereas two patients in the historical control group developed blood-tinged sputum and hematuria. Estimated right ventricular systolic pressure decreased from 47.1 ± 8.6 to 36.2 ± 10.1 mmHg after BT-MAT. Hospital stay did not differ significantly between groups. Conclusions: BT-MAT was technically feasible and showed favorable early clinical outcomes in this small series. Further prospective studies are warranted to evaluate its efficacy and safety.
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Min et al. (2026) conducted a cohort in Intermediate-high- or high-risk acute pulmonary embolism (n=23). Bolus thrombolysis plus manual aspiration thrombectomy (BT-MAT) vs. Conventional management (anticoagulation or systemic thrombolysis) was evaluated on Clinical success (hemodynamic stabilization, improvement or resolution of hypoxia, and survival to discharge without PE-related in-hospital mortality) (Absolute risk difference 16.7 percentage points, 95% CI -14.8 to 48.4, p=0.478). Bolus thrombolysis plus manual aspiration thrombectomy achieved a 100% clinical success rate compared to 83.3% with conventional treatment (p=0.478) in patients with intermediate-high- or high-risk acute pulmonary embolism.
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