Safety and Clinical Outcomes of Aspiration Thrombectomy in Patients with Massive PE: A Single-Center Retrospective Review

This preliminary study seeks to evaluate safety and clinical outcomes for patients with acute massive pulmonary embolism (PE) following aspiration thrombectomy.


Materials and Methods:

This IRB approved single-arm retrospective review was performed on patients with acute massive PE undergoing aspiration thrombectomy between Jan. 2015 and Dec. 2021. An internal procedural database was queried for PE thrombectomy procedures, and electronic health records reviewed for selected periprocedural clinical values, procedural reports and images, and post procedural follow up. Patients were excluded if they had previously failed a course of systemic thrombolysis or if surgical embolectomy was performed, to avoid confounding our assessment of relevant interventions. Primary outcomes were 30-day and one-year mortality, procedure-related complications, and technical success, defined by sufficient removal of thrombus without the need for repeat intervention within 30 days.



Results:

48 patients with massive PE were treated with large-bore suction thrombectomy. Baseline CTs were obtained in 44 patients, with the average RV/LV ratio (1.59 +/- 0.46; n = 42) and mean PA diameter (31.89 +/- 4.77; n = 44) serving as measures of PE severity. 24 patients had an IVC filter placed at the time of their procedure. 4 patients (8.3%) required adjunctive catheter-directed thrombolytic (CDT) therapy, with a mean tPA dose of 9.5mg (range of 4 to 16mg). Technical success was achieved in 81.25% of cases. Complication rate was 18.75% and included insufficient clot retrieval (n=1), pulmonary hemorrhage (n=1), hemodynamic instability requiring reintervention (n=2) or resuscitation/ECMO (n=4), and intra-procedure mortality (n=1). One patient also had occlusion of their IVC filter requiring removal within 10 days. PE recurrence was 6.25% (n=3). 30-day mortality was 25% (n=12) and one year mortality was 45.83% (n=22). Patients requiring CDT demonstrated comparable 30-day mortality (1/4, 25% to 11/44, 25%) but increased complications (2/4, 50% to 7/44, 16%) and mortality at a year (3/4, 75% to 20/44, 45%).



Conclusion:

This single-center retrospective review found high technical success among patients with massive PE. Baseline imaging measurements and mortality rates were similar to prior published results and complication rates were low, further supporting the utilization of large-bore suction thrombectomy for patients with contraindication to systemic lytics. Further studies are needed to understand the potential role of hybrid therapy with catheter-directed thrombolytics.