Real-world comparison of mechanical thrombectomy vs. catheter-directed thrombolysis for the treatment of pulmonary embolism: a single-center retrospective study

A recent multi-site randomized controlled trial, PEERLESS, demonstrated superiority of FlowTriever mechanical thrombectomy (FTMT) to catheter-directed thrombolysis (CDT) in the treatment of intermediate-risk pulmonary embolism using a 5-point composite outcome. The purpose of our study is to review clinical outcomes between these two procedures in actual clinical practice without the use of a composite endpoint using a large sample size. This is a retrospective, single-center analysis of 461 patients who presented with submassive or massive PE and underwent treatment with either FTMT or CDT. No significant difference was observed in 7-day (RR 0.495; <i>p</i> = 0.25) or 30-day mortality (RR 1.347; <i>p</i> = 0.67). There was significantly less risk of procedure-related decompensations within the FTMT group (RR 0.221; <i>p</i> = 0.01). Non-procedure-related decompensations were similar between treatment options (RR 1.091; <i>p</i> = 0.51). ICU LOS was significantly lower for FTMT (mean 1.87 vs. 3.07; <i>p</i> < 0.001) however total LOS was longer within the FTMT (mean 6.85 vs. 5.68; <i>p</i> = 0.008). Similar to PEERLESS, we observed decreased ICU utilization with FTMT in our real-world retrospective data, likely reflecting our practice of ICU admission during thrombolytic administration. We observed slightly lower risk of procedure-related decompensations within the FTMT group, suggesting lower periprocedural morbidity; however, overall mortality between groups was not different.