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. 2023 Oct 25;24(1):257.
doi: 10.1186/s12931-023-02552-w.

Mechanical thrombectomy in intermediate- and high-risk acute pulmonary embolism: hemodynamic outcomes at three months

Lucas Lauder  1 , Patricia Pérez Navarro  2 , Felix Götzinger  2 , Sebastian Ewen  2 , Hussam Al Ghorani  2 , Bernhard Haring  2 , Philipp M Lepper  3 , Saarraaken Kulenthiran  2 , Michael Böhm  2 , Andreas Link  2 , Bruno Scheller  2 , Felix Mahfoud  2
Affiliations

Mechanical thrombectomy in intermediate- and high-risk acute pulmonary embolism: hemodynamic outcomes at three months

Lucas Lauder et al. Respir Res. .

Abstract

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.

Keywords: Mechanical thrombectomy; Pulmonary embolism.

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Conflict of interest statement

LL received speaker honoraria from AstraZeneca, ReCor Medical and Medtronic. FG is supported by the German Foundation of Heart Research and has received speaker honoraria from Astra-Zeneca. SE received speaker honoraria and/or travel support from Akcea Therapeutics, AstraZeneca, Bayer, Berlin Chemie, Bristol-Myers Squibb, Pfizer, Böhringer Ingelheim, Daiichi Sankyo, Edwards Lifesciences, Inari medical, Kaneka Pharma, Medtronic, Novartis and Recor. MB is supported by the Deutsche Forschungsgemeinschaft (German Research Foundation; TTR 219, project number 322900939) and reports personal fees from Abbott, Amgen, Astra Zeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Edwards, Medtronic, Novartis, Recor, Servier and Vifor during the conduct of the study. FM is supported by Deutsche Gesellschaft für Kardiologie (DGK), Deutsche Forschungsgemeinschaft (SFB TRR219), and Deutsche Herzstiftung. He has received scientific support from Ablative Solutions, Medtronic and ReCor Medical and speaker honoraria/consulting fees from Ablative Solutions, Amgen, Astra-Zeneca, Bayer, Boehringer Ingelheim, Inari, Medtronic, Merck, ReCor Medical, Servier, and Terumo. PPN, HAG, BH, PL, SK, AL, and BS report no conflict of interest related to this study.

Figures

Fig. 1
Fig. 1
Systolic pulmonary artery pressure was assessed by right heart catheterization prior and after thrombectomy and at three months of follow-up. Data are means ± SD and mean change (95% CIs).
Fig. 2
Fig. 2
The scatter plot shows the correlation and the simple linear regression line (95% confidence interval) between systolic pulmonary artery pressure (PAP) before thrombectomy and its change on table (A) and at from before thrombectomy to 3 months (B). Pearson’s correlation coefficient was calculated for systolic PAP before thrombectomy and its change during follow-up
Fig. 3
Fig. 3
The figure shows the proportion of patients with mean pulmonary artery pressure (mPAP) > 20 mmHg and ≤ 20 mmHg measured using right heart catheterization immediately before and after thrombectomy and at three months of follow-up
See this image and copyright information in PMC

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