Acute Massive and Submassive Pulmonary Embolism: Preliminary Validation of Aspiration Mechanical Thrombectomy in Patients with Contraindications to Thrombolysis

Abstract

Purpose: The aim of this study is to assess the feasibility of aspiration mechanical thrombectomy in patients with massive and submassive pulmonary embolism (PE) and contraindications to thrombolysis.

Materials and methods: Eighteen patients presenting massive (8/18) or submassive (10/18) PE were prospectively enrolled between October 2016 and November 2017. All the patients enrolled had contraindications to thrombolysis (haemorrhagic stroke n = 1, ischaemic stroke in the preceding 6 months n = 7, central nervous system damage or neoplasms n = 1, recent major trauma/surgery/head injury in the preceding 3 weeks n = 5, gastrointestinal bleeding within the last month n = 4). Eight patients out of 18 (44.44%) were women and 10 (55.55%) were men, with an average age of 74.76 years (range 51-87 years). All the patients were stratified according to the PE severity index (PESI) and the simplified PESI score.

Results: Technical and procedural success was achieved in 18 patients (100%), as per the Society of Interventional Radiology reporting standards definition, while clinical success was achieved in 14 out of 18 patients (78%), with a significant improvement in the pre- and post-procedural right ventricular/left ventricular (RV/LV) ratio, pulmonary oxygen saturation (SpO₂), heart rate, pulmonary artery systolic pressure and the Miller score with a consistent p value of < 0.00001, 0.01, 0.001, < 0.00001 and < 0.00001, respectively. The median days of hospitalization in the intensive care unit was 8.35 days (range 2-12), and during the follow-up, none of the patients developed pulmonary hypertension or PE recurrence.

Conclusion: The high technical and clinical success of the procedure employed in this study suggests that aspiration mechanical thrombectomy is a promising technique when used alone. More extensive prospective studies are needed to assess the feasibility of this treatment.

Keywords: Catheter-directed treatment (CDT); Computed tomography angiography (CTA); Massive pulmonary embolism; Pulmonary embolism (PE); Submassive pulmonary embolism; Thrombolysis.