Mechanical thrombectomy safely reduced systolic pulmonary artery pressure by 23.2 mmHg at three months compared to baseline in patients with acute intermediate- and high-risk pulmonary embolism.
Observational (n=29)
Open-label
No
Does mechanical thrombectomy using the FlowTriever System improve hemodynamic outcomes in patients with acute pulmonary embolism and right heart overload?
Mechanical thrombectomy for acute pulmonary embolism safely and immediately reduces pulmonary artery pressure and improves right heart function, with benefits maintained at three months.
p-value: p=<0.001
BACKGROUND: Mechanical thrombectomy has been shown to reduce thrombus burden and pulmonary artery pressure (PAP) and to improve right ventricular (RV) function in patients with high-risk or intermediate-high-risk pulmonary embolism (PE). As hemodynamic data after mechanical thrombectomy for PE are scarce, we aimed to assess the hemodynamic effects of mechanical thrombectomy in acute PE with right heart overload. METHODS: In this prospective, open-label study, patients with acute symptomatic, computed tomography-documented PE with signs of right heart overload underwent mechanical thrombectomy using the FlowTriever System. Right heart catheterization was performed immediately before and after thrombectomy and after three months. Transthoracic echocardiography was performed before thrombectomy, discharge, and at three months. This analysis was done after 20 patients completed three months of follow-up. RESULTS: Twenty-nine patients (34% female) underwent mechanical thrombectomy, of which 20 completed three months follow-up with right heart catheterization. Most patients were at high (17%) or intermediate-high (76%) risk and had bilateral PE (79%). Before thrombectomy, systolic PAP (sPAP) was severely elevated (mean 51.3 ± 11.6 mmHg). Mean sPAP dropped by -15.0 mmHg (95% confidence interval CI: -18.9 to -11.0; p < 0.001) immediately after the procedure and continued to decrease from post-thrombectomy to three months (-6.4 mmHg, 95% CI: -10-0 to -2.9; p = 0.002). RV/left ventricular (LV) ratio immediately reduced within two days by -0.37 (95% CI: -0.47 to -0.27; p < 0.001). The proportion of patients with a tricuspid annular plane systolic excursion (TAPSE)/sPAP ratio < 0.31 mm/mmHg decreased from 28% at baseline to 0% before discharge and at three months (p = 0.007). There were no procedure-related major adverse events. CONCLUSIONS: Mechanical thrombectomy for acute PE was safe and immediately reduced PAP and improved right heart function. The reduction in PAP was maintained at three months follow-up.
Lauder et al. (Wed,) conducted a observational in Acute intermediate- and high-risk pulmonary embolism with right heart overload (n=29). Mechanical thrombectomy (FlowTriever System) was evaluated on Change in systolic pulmonary artery pressure (sPAP) from baseline to 3 months (95% CI -28.5 to -17.8, p=<0.001). Mechanical thrombectomy safely reduced systolic pulmonary artery pressure by 23.2 mmHg at three months compared to baseline in patients with acute intermediate- and high-risk pulmonary embolism.