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SVS-VESS Scientific Session @ VAM: Session 2a

VESS15 - Comparative Effectiveness of Suction Thrombectomy vs. Catheter-Directed Thrombolysis in Intermediate-Risk Pulmonary Embolism

Wednesday, June 19, 2024
3:41 PM – 3:48 PM CT
Location: West Building, Level 1, W184bc
Objectives: Catheter directed thrombolysis (CDT) has been shown to rapidly reverse hemodynamic and echocardiographic abnormalities seen in intermediate-risk pulmonary embolism (IRPE). Suction thrombectomy (ST) devices have emerged as alternative treatment modalities demonstrating immediate results, obviating the need for thrombolytics. Comparative data between the two methods are sparse.

Methods: We retrospectively reviewed interventions for IRPE (CDT or ST) at a multi-hospital healthcare system (2017-2022). IRPE was defined by evidence of right heart strain (RHS) on imaging (echocardiogram and/or CT-angiography) or elevated biomarkers (troponin or B-natriuretic peptide). Patients with high-risk PE (systolic blood pressure < 90 mmHg) or those who received systemic thrombolytics were excluded. The primary endpoint was a composite of 7-day all-cause mortality, intracranial bleeding, major bleeding, clinical deterioration and/or need for bailout therapy. Secondary outcomes included the primary endpoint as individual components, intensive care unit length-of-stay (ICULOS), 30-day mortality and resolution of RHS at 3 months. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline imbalances between groups, generating weighted odds ratios (wOR).

Results: 332 patients were included with 150 CDT and 182 ST. IPTW successfully balanced baseline differences between groups (Table I). On univariable analysis, the primary outcome did not differ across treatments (CDT 13.3% vs ST 15.9%; p=0.506). Major bleeding occurred in 2.7% CDT vs 2.7% ST (p=1.000). There were no intracranial bleeds. Fatal bleeding occurred in 1 CDT patient (0.7%) and no ST patients. In the IPTW adjusted analysis, no difference was seen between groups in the primary endpoint (wOR 1.08, 95% CI [0.42-2.68], p=0.860) or the individual components (Table II) . ICULOS was significant longer in the ST group before weighting (median 1.68 days CDT vs 2.09 days ST, p=0.0009), but this difference was no longer present on the adjusted analysis. The use of ST for IPRE was significantly associated with resolution of RHS (wOR 2.89, 95% CI [1.16-7.21], p=0.023).

Conclusions: Similar short-term outcomes were observed for IPRE treated with CDT or ST. Based on these data, ST appears to be a safe and viable alternative to CDT. In this modern cohort, there was no statistically significant reduction in major bleeding compared to CDT, with both modalities having very low bleeding risk. RHS resolved more frequently in patients after ST, suggesting there may be benefit to rapid thrombus removal in appropriately selected IPRE patients.