Interventional Therapy in Pulmonary Embolism Treatment: Expanding Benefits and Advancing Safety

Acute pulmonary embolism (PE) remains a global health challenge with significant morbidity and mortality.High-risk PE, characterized by hemodynamic instability, and intermediate-risk PE, with evidence of right ventricular (RV) dysfunction, pose distinct therapeutic challenges.Traditionally, systemic thrombolysis and surgical embolectomy have been the primary therapeutic strategies.However, both approaches come with limitations, such as bleeding risks in thrombolysis and resource-intensive requirements in surgical embolectomy.In response, percutaneous catheter-directed therapies, including mechanical thrombectomy and catheter-directed thrombolysis (CDT), have emerged as promising alternatives.The CLEAR study, a multicenter, prospective, single-arm trial conducted across 15 centers in China, evaluated 127 patients with intermediate-risk acute PE [1].The study's primary efficacy endpoint -a reduction in the RV/left ventricular (LV) diameter ratio at 48 hours post-procedure -was achieved with a mean decrease of 0.42 ± 0.28 (P < 0.001).This result is consistent with findings from the EXTRACT-PE (0.43) and FLARE (0.38) studies, underscoring the reliability of mechanical thrombectomy in restoring RV function [2,3].Safety outcomes were equally noteworthy.The study reported no major adverse events (MAEs) within 48 hours, and the incidence of serious adverse events was low at 5.7% over 30 days.These favorable safety results can be attributed to the Tendvia system's innovative design, which incorporates adaptive mesh structures to optimize thrombus capture while minimizing vascular injury.Compared to the FLARE study, both trials enrolled intermediate-risk PE patients and employed single-arm designs without control groups for anticoagulation or thrombolysis.However, the CLEAR study demonstrated a higher safety profile, with no reported MAEs within 48 hours, emphasizing the Tendvia system's ability to reduce vascular injury [1].The CLEAR study introduces compelling evidence supporting the safety and efficacy of the Tendvia system, a novel mechanical thrombectomy device, for intermediate-risk acute PE [1].This editorial explores the advancements in percutaneous therapies for PE, with an emphasis on mechanical thrombectomy, by integrating findings from the CLEAR study, FLARE study, FLASH registry, and other landmark research [1,3,4].