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Comparative Study
. 2025 Jul;106(1):53-63.
doi: 10.1002/ccd.31386. Epub 2024 Dec 26.

Comparing Real-World Outcomes of Catheter-Directed Thrombolysis and Catheter-Based Thrombectomy in Acute Pulmonary Embolism: A Post PEERLESS Analysis

Robert S Zhang  1 , Peter Zhang  2 , Eugene Yuriditsky  3 , Bedros Taslakian  4 , Aaron J Rhee  2 , Allison A Greco  5 , Lindsay Elbaum  3 , Vikramjit Mukherjee  5 , Radu Postelnicu  5 , Nancy E Amoroso  5 , Thomas S Maldonado  6 , Carlos L Alviar  3 , James M Horowitz  3 , Sripal Bangalore  3
Affiliations
Comparative Study

Comparing Real-World Outcomes of Catheter-Directed Thrombolysis and Catheter-Based Thrombectomy in Acute Pulmonary Embolism: A Post PEERLESS Analysis

Robert S Zhang et al. Catheter Cardiovasc Interv. 2025 Jul.

Abstract

Background: The recently published PEERLESS trial compared catheter-directed thrombolysis (CDT) and catheter-based thrombectomy (CBT) in acute pulmonary embolism (PE). However, it included a low proportion of patients with contraindications to thrombolytic therapy (4.4%), leaving uncertainty about how CDT would perform relative to CBT in a real-world cohort with higher bleeding risk.

Aims: This study aims to address this gap by comparing real-world outcomes of CDT and CBT in patients with acute PE.

Methods: This retrospective analysis included patients who underwent CDT and CBT at two tertiary care centers from January 2020 to January 2024. The primary outcome was a composite of 30-day mortality, resuscitated cardiac arrest, or hemodynamic decompensation. Secondary outcomes included major bleeding and intracranial hemorrhage (ICH). Inverse probability treatment weighting (IPTW) was used to adjust for baseline variables.

Results: A total of 162 (mean age 58 years, 45.7% women, 17.3% high-risk, 28% contraindication to lytics, 28% CDT, 72% CBT) patients were included, with 12.4% patients experiencing the primary outcome. There was no difference in the rates of the primary outcome between CBT versus CDT (11.2% vs. 15.2%, IPTW HR: 0.80; 95% CI: 0.27-2.38, p = 0.69). CBT was associated with a lower risk of hemodynamic decompensation (5% vs. 21.7%, p = 0.036), major bleeding (7.8% vs. 17.4%, IPTW HR 0.26; 95% CI: 0.07-0.95, p = 0.042) and ICH (0 vs. 4.3%, p = 0.024) compared to CDT.

Conclusion: Among a real-world cohort of patients with acute PE with higher bleeding risk than PEERLESS undergoing catheter-based therapies, CBT was associated with a lower rate of hemodynamic deterioration, major bleeding, and ICH with similar rate of primary composite outcome when compared with CDT. Additional randomized controlled trials are needed to validate these findings.

Keywords: anticoagulation; catheter; pulmonary embolism; thrombectomy; thrombolysis.

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References

    1. R. Zhang, T. Kobayashi, S. Pugliese, S. Khandhar, and J. Giri, “Interventional Therapies in Acute Pulmonary Embolism,” Interventional Cardiology Clinics 9, no. 2 (April 2020): 229–241, https://doi.org/10.1016/j.iccl.2019.12.003.
    1. M. H. Maqsood, R. Zhang, D. Zlotnick, S. Parikh, and S. Bangalore, “Outcomes With Treatment Interventions for Clot‐in‐Transit in Patients With Pulmonary Embolism: A Meta‐Analysis,” Journal of Invasive Cardiology. Published ahead of print, May 21, 2024, https://doi.org/10.25270/jic/24.00089.
    1. R. Bashir, M. Foster, A. Iskander, et al., “Pharmacomechanical Catheter‐Directed Thrombolysis With the Bashir Endovascular Catheter for Acute Pulmonary Embolism,” JACC: Cardiovascular Interventions 15, no. 23 (December 2022): 2427–2436, https://doi.org/10.1016/j.jcin.2022.09.011.
    1. N. Kucher, P. Boekstegers, O. J. Müller, et al., “Randomized, Controlled Trial of Ultrasound‐Assisted Catheter‐Directed Thrombolysis for Acute Intermediate‐Risk Pulmonary Embolism,” Circulation 129, no. 4 (January 2014): 479–486, https://doi.org/10.1161/circulationaha.113.005544.
    1. T. Tu, C. Toma, V. F. Tapson, et al., “A Prospective, Single‐Arm, Multicenter Trial of Catheter‐Directed Mechanical Thrombectomy for Intermediate‐Risk Acute Pulmonary Embolism,” JACC: Cardiovascular Interventions 12, no. 9 (2019): 859–869, https://doi.org/10.1016/j.jcin.2018.12.022.

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