Mechanical thrombectomy in intermediate- and high-risk acute pulmonary embolism: hemodynamic outcomes at three months

Respiratory Research

Research

Andreas Link¹  Lucas Lauder¹  Felix Mahfoud¹  Michael Böhm¹  Patricia Pérez Navarro¹  Hussam Al Ghorani¹  Saarraaken Kulenthiran¹  Sebastian Ewen¹  Felix Götzinger¹  Bernhard Haring¹  Bruno Scheller¹  Philipp M. Lepper² 

[1] Klinik für Innere Medizin III – Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany;Klinik für Innere Medizin V – Pneumologie, Allergologie und Intensivmedizin, Universitätskliniken des Saarlandes und Universität des Saarlandes, Homburg, Germany;

关键词: Pulmonary embolism;    Mechanical thrombectomy;   

DOI  :  10.1186/s12931-023-02552-w

 received in 2023-06-09, accepted in 2023-10-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMechanical thrombectomy has been shown to reduce thrombus burden and pulmonary artery pressure (PAP) and to improve right ventricular (RV) function in patients with high-risk or intermediate-high-risk pulmonary embolism (PE). As hemodynamic data after mechanical thrombectomy for PE are scarce, we aimed to assess the hemodynamic effects of mechanical thrombectomy in acute PE with right heart overload.MethodsIn this prospective, open-label study, patients with acute symptomatic, computed tomography-documented PE with signs of right heart overload underwent mechanical thrombectomy using the FlowTriever System. Right heart catheterization was performed immediately before and after thrombectomy and after three months. Transthoracic echocardiography was performed before thrombectomy, discharge, and at three months. This analysis was done after 20 patients completed three months of follow-up.ResultsTwenty-nine patients (34% female) underwent mechanical thrombectomy, of which 20 completed three months follow-up with right heart catheterization. Most patients were at high (17%) or intermediate-high (76%) risk and had bilateral PE (79%). Before thrombectomy, systolic PAP (sPAP) was severely elevated (mean 51.3 ± 11.6 mmHg). Mean sPAP dropped by -15.0 mmHg (95% confidence interval [CI]: -18.9 to -11.0; p < 0.001) immediately after the procedure and continued to decrease from post-thrombectomy to three months (-6.4 mmHg, 95% CI: -10-0 to -2.9; p = 0.002). RV/left ventricular (LV) ratio immediately reduced within two days by -0.37 (95% CI: -0.47 to -0.27; p < 0.001). The proportion of patients with a tricuspid annular plane systolic excursion (TAPSE)/sPAP ratio < 0.31 mm/mmHg decreased from 28% at baseline to 0% before discharge and at three months (p = 0.007). There were no procedure-related major adverse events.ConclusionsMechanical thrombectomy for acute PE was safe and immediately reduced PAP and improved right heart function. The reduction in PAP was maintained at three months follow-up.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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