A single center experience on percutaneous thrombectomy of pulmonary embolism

Pulmonary embolism (PE) is the third most common cause of cardiovascular death, after myocardial infarction and stroke, with a significant socioeconomic impact and nearly one million deaths annually worldwide. The pathophysiology of PE involves pulmonary vascular obstruction, acute inflammation, and vasospasm. During the acute phase, obstruction leads to an increase in right heart workload, which can result in right ventricular dysfunction, heart failure, and hypoxia. PE patients are divided into three risk categories (low, intermediate, and high), with treatment depending on the severity of the condition. Low-risk patients are treated with anticoagulants, while those at intermediate-high or high risk may require systemic thrombolysis or interventional treatments. Although thrombolysis is effective, it carries an increased risk of bleeding and is used in only a minority of high-risk PE patients. In our center, we have developed an internal protocol, structured in a multidisciplinary setting, for the treatment and management of patients with high or intermediate-high risk PE, who may benefit from endovascular treatment with mechanical thrombectomy, in association with systemic therapy, unless contraindications are present. Over a three-year period (from January 2022 to December 2024), 35 patients with PE who met the inclusion criteria of our protocol were treated with mechanical thrombectomy, possibly combined with systemic thrombolysis. The patients then underwent instrumental and clinical follow-up in the months following the procedure.