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Review
. 2025 Jun 12;14(12):4167.
doi: 10.3390/jcm14124167.

Catheter-Based Therapies in Acute Pulmonary Embolism-Mortality and Safety Outcomes: A Systematic Review and Meta-Analysis

Panagiotis Zoumpourlis  1 , Shaunak Mangeshkar  1 , Kuan-Yu Chi  1 , Dimitrios Varrias  1 , Michail Spanos  1 , Muhammad Fahimuddin  1 , Matthew D Langston  1 , Usman A Khan  1 , Michael J Grushko  1 , Prabhjot Singh  1 , Seth I Sokol  1
Affiliations
Review

Catheter-Based Therapies in Acute Pulmonary Embolism-Mortality and Safety Outcomes: A Systematic Review and Meta-Analysis

Panagiotis Zoumpourlis et al. J Clin Med. .

Abstract

Background/Objectives: Right ventricular (RV) dysfunction and circulatory collapse are considered to play a major role in mortality in patients suffering from pulmonary embolism (PE). Catheter-based therapies (CBTs) have been shown to improve RV hemodynamics. The aim of this study was to present available data for CBTs in acute PE and investigate whether CBTs offer mortality benefit and better safety outcomes over anticoagulation (AC) in patients with intermediate-risk PE. Methods: PubMed was searched from inception until February 2024 for studies that investigated treatment strategies in patients with confirmed PE. We initially investigated the crude incidence of mortality and major bleeding for individual interventions in patients with either intermediate or high-risk PE. We then directly compared CBT to AC for intermediate-risk PE, for which the effectiveness endpoint was comparative short-term (30-day or in-hospital) and midterm (90-day or 1-year) all-cause mortality and the safety outcomes included minor bleeding, major bleeding, and intracranial hemorrhage (ICH). Results: In all, 59 studies (4457 patients) were eventually included in our study. For the prevalence study, we described the crude incidence for mortality and major bleeding for interventions like catheter-directed thrombolysis (CDT), mechanical thrombectomy (MT), AC, and systemic thrombolysis (ST) in patients with either intermediate or high-risk PE. Our data synthesis comparing CBT to AC included 1657 patients (11 studies) with intermediate-risk PE. Our results indicate that CBT is associated with a lower risk of both short-term (RR 0.43; 95% CI [0.24-0.79], I2 = 0%) and midterm all-cause mortality (RR 0.38; 95% CI [0.23-0.62], I2 = 0%) compared to AC. Major bleeding and ICH did not differ between the two groups. Conclusions: In patients with intermediate-risk PE, our meta-analysis of the current literature suggests that CBT offers better outcomes in terms of short-term and midterm mortality compared to AC alone, with no difference in safety outcomes. Further RCTs are needed to explore and validate these findings.

Keywords: acute pulmonary embolism; catheter-based therapy; catheter-directed thrombolysis; intermediate-risk pulmonary embolism; mechanical thrombectomy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Cumulative mortality among included studies [11,15,16,17,18,19,20,21,22,23,24,25,26,28,30,31,32,33,37,38,39,42,43,48,49,50,51,52,53,55,57,58,60,61,62,63,64,65,66,67,68,70,72].
Figure 3
Figure 3
Cumulative incidence of bleeding among included studies [15,16,17,18,19,20,21,22,23,24,25,28,30,31,32,37,38,39,40,42,43,48,50,51,52,53,55,57,58,60,61,63,64,65,67,70,72].
Figure 4
Figure 4
(A) A forest plot for comparative short-term and midterm all-cause mortality of CBT vs. AC. (B) A funnel plot for comparative short-term mortality between CBT and AC [11,22,62,63,64,65,66,67,68,69].
Figure 5
Figure 5
A forest plot for comparative (A) minor bleeding, (B) major bleeding and (C) ICH between CBT vs. AC [11,22,43,62,63,64,65,67].
Figure 6
Figure 6
Risk of bias for RCTs using RoB2 [11,63,64].
Figure 7
Figure 7
Risk of bias for observational studies using ROBINS-V2 [22,43,62,65,66,67,68,69].
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