Mechanical Thrombectomy and Catheter-Directed Lysis in Treating Intermediate-Risk Pulmonary Embolization: 30-Day Outcome

Intermediate risk pulmonary embolism (IRPE) is defined as dilatation of the right ventricular (RV) and evidence of myocardial necrosis with stable hemodynamics in the setting of acute PE. The differences in performance among the various devices in treating IRPE remain unclear. We reviewed consecutive patients treated at 2 medical centers between January 1, 2019, and December 31, 2022, using PMC devices (FlowTriever [Inari Medical] or Ekos [Boston Scientific]). Demographics, clinical, procedural variables, in-hospital complications, and 30-day outcomes were recorded from patients' medical records. Descriptive analyses were performed. The study's primary endpoint was the mean change in the RV/LV ratio. Safety endpoints included procedural complications 30-day mortality and major bleeding. 97 consecutive patients (43 FlowTriever, 54 Ekos) were included. The mean age was 64.16 ± 13.37 years. When compared with pretreatment, PMC reduced significantly the RV/LV ratio (0.55 ± 0.49, 95% CI: 0.40, 0.71, <i>p</i> < 0.0001) and PA pressures (17.98 ± 14.72 mm Hg, 95% CI:10.88, 25.07, <i>p</i> < 0.0001) with no differences seen between the FlowTriever and Ekos. At 30-day, all-cause mortality and major bleeding were 5.2 and 7.2%, respectively, and were similar between the FlowTriever and Ekos, respectively (4.7% vs. 5.6% ( <i>p</i> = 0.935) and 7.0% vs. 7.4% ( <i>p</i> = 0.935)). The Ekos, however, had a shorter procedure time, and less fluoroscopy and contrast use. PMC devices reduced significantly the RV/LV ratio and PA pressures when compared with the baseline. No differences were seen between the FlowTriever and Ekos. Thirty-day mortality and major bleeding were statistically similar between the two devices.