Early Outcomes of Bolus Thrombolysis Plus Manual Aspiration Thrombectomy Using Conventional Catheters for Intermediate-High- and High-Risk Acute Pulmonary Embolism

Background: Dedicated pulmonary embolism (PE) thrombectomy devices are not universally available. We evaluated the early outcomes and safety of catheter-directed bolus thrombolysis plus manual aspiration thrombectomy (BT-MAT) using conventional catheters for intermediate-high- or high-risk acute PE. Methods: This retrospective, single-center, historical control study included adults with acute intermediate-high- or high-risk PE involving the main pulmonary artery. Patients who underwent BT-MAT from November 2023 to October 2025 were compared with historical controls who received conventional management such as anticoagulation or systemic thrombolysis before BT-MAT implementation (November 2022 to October 2023). BT-MAT comprised catheter-directed bolus alteplase injection followed by manual aspiration using conventional 7- to 8-Fr catheters or sheaths. Results: Twenty-three patients were included (BT-MAT, n = 11; historical control, n = 12). BT-MAT patients were younger (65.3 ± 16.5 vs. 78.2 ± 11.4 years; p = 0.040) and more frequently had bilateral main pulmonary artery involvement (82% vs. 33%; p = 0.036). Technical success was achieved in all BT-MAT procedures. Clinical success occurred in 11/11 BT-MAT patients and 10/12 conventional-treatment patients (100.0% vs. 83.3%; p = 0.478). No treatment-related complications occurred in the BT- MAT group, whereas two patients in the historical control group developed blood-tinged sputum and hematuria. Estimated right ventricular systolic pressure decreased from 47.1 ± 8.6 to 36.2 ± 10.1 mmHg after BT-MAT. Hospital stay did not differ significantly between groups. Conclusions: BT-MAT was technically feasible and showed favorable early clinical outcomes in this small series. Further prospective studies are warranted to evaluate its efficacy and safety.