Catheter-directed thrombectomy in acute pulmonary embolism and angiographic signs of chronic thromboembolic pulmonary disease

BACKGROUND: Angiographic signs of chronic thromboembolic pulmonary hypertension or disease (CTEPH/D) are frequently found during large-bore thrombectomy (LBT) in acute pulmonary embolism (PE). Data on the incidence of CTEPH/D signs and outcome after LBT are lacking. These angiographic signs are not equivalent to a confirmed diagnosis of CTEPH/D. AIMS: To investigate the efficacy and safety of LBT in patients with acute PE and angiographic signs of CTEPH/D compared to patients without (N-CTEPH/D). METHODS: In total, 250 patients from five centers (CTEPH/D = 98, N-CTEPH/D = 152) were retrospectively analyzed. Efficacy of LBT was assessed by comparing clinical, echocardiographic, and invasive data between the groups. Safety endpoints included periprocedural death, procedural complications, or bleeding defined as the need for blood transfusion or hemoglobin drop of at least 5 g/dl. RESULTS: At baseline, the CTEPH/D group had higher systolic pulmonary artery pressure (sPAP) (CTEPH/D: 54 ± 14 mmHg, N-CTEPH/D: 49 ± 13 mmHg, p = 0.006). After LBT, right ventricular/left ventricular-ratio (CTEPH/D: - 0.30 ± 0.26, N-CTEPH/D: - 0.27 ± 0.32, p < 0.001 for both), sPAP (CTEPH/D: - 13 ± 8, N-CTEPH/D: - 11 ± 8 mmHg, p < 0.001 for both), heart rate (CTEPH/D: - 19 ± 20 beats/min, N-CTEPH/D: - 21 ± 15 beats/min, p < 0.001 for both) and respiratory rate (CTEPH/D: - 6 ± 6 respirations/min, N-CTEPH/D: by - 8 ± 7 respirations /min, p < 0.001 for both) were significantly reduced in both groups without significant differences. Peri-interventional safety was comparable between groups. CONCLUSION: LBT appears to be safe and effective in patients with acute PE and angiographic signs of CTEPH/D. Long-term effects should be further investigated.