Indigo Thrombectomy System: A Case Series of Catheter-directed Fibrinolysis in High-risk Pulmonary Embolism

High-risk and intermediate–high-risk pulmonary embolism (PE) is usually treated by systemic fibrinolysis or catheter-based therapy. Intracranial hemorrhage can occur in 1%–3% of patients receiving systemic fibrinolysis. Catheter-based techniques are a safer alternative to systemic fibrinolysis and sometimes are the only option in high-risk PE in a patient with high bleeding risk. The various catheter-based techniques studied include ultrasound-facilitated fibrinolysis, FlowTriever system, and Indigo aspiration system. The data on the use of the Indigo thrombectomy system in high-risk PE is scarce yet relevant in day-to-day clinical practice. We describe two high-risk PE cases, in which the CAT8 Indigo thrombectomy system was used safely and effectively. Two octogenarian patients presenting with high-risk acute PE are described, both showing features of hemodynamic compromise at presentation. Computed tomography pulmonary angiography showed thrombus in both right and left pulmonary arteries in both the patients. The CAT8 Indigo aspiration system was used for catheter-based intervention. A final pulmonary angiogram was taken, and there was prompt hemodynamic improvement. The Indigo aspiration system is a safe and effective technique for high-risk acute PE. It is associated with a lower risk of major bleeding and can be done with 8F access with a lower risk of access site complications.