052 - Improvement in Clinical and Echo Parameters After Aspiration Thrombectomy for Treatment of Acute Pulmonary Embolism
Greg Miller, DO – Chief Fellow, Cardiology, Cooper University Hospital
Purpose: To evaluate recovery in patients with acute pulmonary embolism (PE), clinicians rely on clinical parameters and imaging. Right ventricular (RV) size and clot burden are typically evaluated by using computed tomography; however, echocardiography (echo) has also proven to provide clinically meaningful measures of RV function. This study evaluated improvement in clinical and echo parameters after treating acute PE patients with computer-aided mechanical aspiration thrombectomy with the Indigo Lightning 12 Aspiration System (Lightning 12; Penumbra, Inc., Alameda, CA).
Material and Methods: We performed a single-center retrospective review of patients treated with Lightning 12 for acute PE. Clinical and echo parameters were measured pre-procedure, 48 hours post-procedure, and at long-term follow-up. The clinical parameters evaluated were the abnormal clinical findings of heart rate > 110 bpm, systolic blood pressure < 100 mmHg, respiratory rate > 30 bpm, and O2 saturation < 90% on room air. The echo parameters evaluated included pulmonary artery systolic pressure (PASP), RV outflow tract velocity time integral (VTI), left ventricular (LV) outflow tract VTI, RV/LV ratio, acceleration time, VTI/PASP, tricuspid annular plane systolic excursion, and McConnell sign. Safety measures were also evaluated.
Results: This analysis included 101 patients (mean age 61.9 years; 46.5% female). Nine patients (8.9%) were classified as intermediate-low risk; 85 patients (84.2%), intermediate-high risk; and 7 patients (6.9%), high risk. Median time from symptom onset to procedure was 3.9 days. Median thrombectomy time was 18.3 minutes.
Substantial or statistically significant (P < .001) improvement in all clinical and echo parameters occurred from pre- to post-procedure. The median pulmonary embolism severity index score decreased by 22 points (26.0%) from baseline to 72 hours post-procedure. Procedure-related major bleeding occurred in 1 patient (1.0%). In-hospital death, due to pre-existing pneumonia, occurred in 3 patients (3.0%). No cases of arrythmia or cardiac complication occurred. At an average of 11.5 months post-procedure, 90.1% (20/22) patients had normal RV size and function.
Conclusions: Treatment of acute PE with computer-aided mechanical aspiration thrombectomy rapidly improved clinical and echo parameters. This was accomplished with a short procedure time and an acceptable safety profile.