Large-Bore Aspiration Thrombectomy versus Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Propensity Score–Matched Comparison

Graif, Assaf; Patel, Keval D.; Wimmer, Neil J.; Kimbiris, G.; Grilli, C.; Upparapalli, Deepti; Kaneria, Amar; Leung, Daniel A.

doi:10.1016/j.jvir.2020.08.028

Cited by 28 publications

(7 citation statements)

References 18 publications

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“…Another study by Graif et al evaluated thrombectomy with the INARI device and revealed an approximate reduction of 11.5% in hemoglobin, which was not significantly different than the reduction in the catheterdirected thrombolysis group although they did not comment if this was a statistically significant hemoglobin drop pre-and post-procedurally. Comparatively, our cohort had a mean difference of 1.55 g/dL pre-and post-FlowTriever use which is a similar result to both studies by Graif et al and Wible et al [13,14].…”

Section: Discussionsupporting

confidence: 89%

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Outcomes of Catheter-Based Pulmonary Artery Embolectomy in Patients With Sub-Massive to Massive Pulmonary Embolism

Elmoghrabi¹,

Shafi²,

Abdelrahman³

et al. 2023

Cureus

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BackgroundPulmonary embolism (PE) is the third leading cause of cardiovascular death after myocardial infarction and stroke. The ideal therapeutic approach for these patients remains undetermined. We report our single-center outcome data for using a catheter-based pulmonary artery thrombectomy using the FlowTriever (Inari Medical, Irvine, CA) device as management for patients with submassive PE. MethodsWe retrospectively collected data from a single center of patients who underwent thrombectomy using INARI FlowTriever device. The data on baseline characteristics, procedural and clinical outcomes was collected and analysed ResultsA total of 38 patients with PE treated endovascularly with the FlowTriever device were identified: 33 with submassive PE and five with massive PE. The mean age was 65.9 years (95% CI 61.9 -69.8), and most patients were male (73.7%). All patients had right heart strain as the main indication for thrombectomy. Four patients (10.53%) required pressor support before the procedure. In 31 patients, pre-and postthrombectomy average mean pulmonary artery pressure (mPAP) was improved significantly by 22% (p < 0.01). Two patients had significant adverse events at 48 hours (5.26%). One patient experienced procedurerelated access site hematoma and life-threatening bleeding, while another developed intraproceduralrelated massive hemoptysis and cardiopulmonary arrest. Overall post-procedural length of stay was 7.7 ± 5.6 days; 52.63% of patients (n = 20) required intensive care. Three patients (7.89%) required pressor support before the procedure, and 78.9% of patients (n = 30 of 38) survived hospital discharge. Thirty patients who survived were discharged with oral anticoagulation. There were no device-related complications. ConclusionRandomized trials of interventional devices for submassive PE are warranted to either support or alert the medical community of the safety and efficacy of their use for patients with submassive and massive PE. In time, pulmonary embolism response team (PERT) may generate outcome data that better inform treatment decisions.

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Section: Discussionsupporting

confidence: 89%

“…There was only one patient requiring blood transfusion and the study did not comment on major bleeding. They did note a maximum single case of blood loss was attributed to the operator's initial use of the device and decreased with operator experience [13].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Catheter-Based Pulmonary Artery Embolectomy in Patients With Sub-Massive to Massive Pulmonary Embolism

Elmoghrabi¹,

Shafi²,

Abdelrahman³

et al. 2023

Cureus

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“…There were no randomized control trials (RCTs) comparing one type of fragmentation or thrombectomy technique to another. After full-text review, 14 studies met the inclusion criteria 8,9,[20][21][22][23][24][25][26][27][28][29][30][31] (Figure 1). Among the 14 included studies, four were prospective case series and 10 were retrospective case series.…”

Section: Studies Meeting Inclusion Criteriamentioning

confidence: 99%

Mechanical aspiration thrombectomy for the treatment of pulmonary embolism: A systematic review and meta-analysis

et al. 2022

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Introduction: There are no randomized trials studying the outcomes of mechanical aspiration thrombectomy (MAT) for management of pulmonary embolism (PE). Methods: We performed a systematic review and meta-analysis of existing literature to evaluate the safety and efficacy of MAT in the setting of PE. Inclusion criteria were as follows: studies reporting more than five patients, study involved MAT, and reported clinical outcomes and pulmonary artery pressures. Studies were excluded if they failed to separate thrombectomy data from catheter-directed thrombolysis data. Databases searched include PubMed, EMBASE, Web of Science until April, 2021. Results: Fourteen case series were identified, consisting of 516 total patients (mean age 58.4 ± 13.6 years). Three studies had only high-risk PE, two studies had only intermediate-risk PE, and the remaining nine studies had a combination of both high-risk and intermediate-risk PE. Six studies used the Inari FlowTriever device, five studies used the Indigo Aspiration system, and the remaining three studies used the Rotarex or Aspirex suction thrombectomy system. Four total studies employed thrombolytics in a patient-specific manner, with seven receiving local lysis and 17 receiving systemic lysis, and 40 receiving both. A random-effects meta-analyses of proportions of in-hospital mortality, major bleeding, technical success, and clinical success were calculated, which yielded estimate pooled percentages [95% CI] of 3.6% [0.7%, 7.9%], 0.5% [0.0%, 1.8%], 97.1% [94.8%, 98.4%], and 90.7% [85.5%, 94.3%]. Conclusion: There is significant heterogeneity in clinical, physiologic, and angiographic data in the currently available data on MAT. RCTs with consistent parameters and outcomes measures are still needed.

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“…A previous study has shown a higher‐procedure related mortality in patients undergoing MT compared to CDL, 12 but that study only included 26 patients in each arm. In the said study, CDL was associated with a better reduction in the PE obstruction scrore as assessed by CT scan.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy versus catheter directed thrombolysis in patients with pulmonary embolism: A multicenter experience

Inci

Khandhar

Toma

et al. 2022

Cathet Cardio Intervent

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Objectives: Compare in-hospital outcomes of patients treated with either mechanical thrombectomy (MT) or catheter directed lysis (CDL) in treatment of acute pulmonary embolism (PE).Methods: This is a multicenter, retrospective cohort study of patients undergoing MT or CDL for acute PE between 2014 and 2021. The primary outcome was the composite of in-hospital death, significant bleed, vascular complication, or need for mechanical support post-procedure. Secondary outcomes included the individual components of the composite outcome in addition to blood transfusions, invasive hemodynamics, echocardiographic data, and intensive care unit (ICU) utilization.Results: 458 patients were treated for PE with 266 patients in the CDL arm and 192 patients in the MT arm. The primary composite endpoint was not significantly different between the two groups with CDL 12% versus MT 11% (p = 0.5). There was a significant difference in total length of ICU time required with more in the CDL group versus MT (3.8 ± 2.0 vs. 2.8 ± 3.0 days, p = 0.009). All other secondary end points showed no significant difference between the groups.Conclusions: In patients undergoing catheter directed treatment of PE, there was no difference between MT and CDL in terms of in-hospital mortality, bleeds, catheterrelated complications, and hemodynamics.

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Large-Bore Aspiration Thrombectomy versus Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Propensity Score–Matched Comparison

Cited by 28 publications

References 18 publications

Outcomes of Catheter-Based Pulmonary Artery Embolectomy in Patients With Sub-Massive to Massive Pulmonary Embolism

Outcomes of Catheter-Based Pulmonary Artery Embolectomy in Patients With Sub-Massive to Massive Pulmonary Embolism

Mechanical aspiration thrombectomy for the treatment of pulmonary embolism: A systematic review and meta-analysis

Mechanical thrombectomy versus catheter directed thrombolysis in patients with pulmonary embolism: A multicenter experience

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