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One-year outcomes of Mechanical Thrombectomy and Catheter-Directed Thrombolysis in Acute Pulmonary Embolism at a Single Hospital System
Bright Benfor1, Pallavi Gorantla
2, Sri Achanta
3, Eric K. Peden
1
1Houston Methodist Hospital, Houston, TX;2University of Texas at Austin, Austin, TX;3School of Engineering, TAMU, College Station, TX
INTRODUCTION:Acute pulmonary embolism (PE) is the third leading cause of cardiovascular mortality in the United States. Mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT) have emerged as effective interventional options for clot removal. However, longitudinal outcomes remain poorly defined. This study aimed to compare the one-year outcomes of MT and CDT for acute PE.
METHODS:We conducted a retrospective cohort study of all patients who underwent MT or CDT in our institution between 2021 and 2025. Patients were stratified based on the treatment received. Baseline characteristics, procedural data, and clinical outcomes were analyzed. The primary endpoint was mortality. Secondary endpoints included length of hospital stay, major adverse events, reintervention, and PE recurrence. Patients were followed for up to one year or until death.
RESULTS:A total of 724 patients were included: 569 (79%) underwent MT and 155 (21%) received CDT. The mean age was 63 ± 16 years, and 49% were female. Most patients (76%) were classified as intermediate-high risk, with a mean right ventricle to left ventricle (RV/LV) ratio of 1.5 ± 0.5. Bilateral or saddle embolism was present in 93% of cases. Patients in the MT group were more likely to have a simplified PE severity index (sPESI) > 0 (73% vs. 60%, p < 0.001). Age, rates of cancer, chronic cardiopulmonary disease, and concurrent deep vein thrombosis were similar between groups. However, prior PE was more common in the CDT group, while recent surgery was more common in the MT group.Median procedure duration was longer for MT (66 minutes, IQR 46-89) than CDT (58 minutes, IQR 40-77; p = 0.003). Median postoperative length of stay was 3 days in both groups. Thirty-day mortality was numerically lower in the CDT group (1.9% vs. 4.6%) but did not reach statistical significance (p = 0.14). MT was associated with a higher incidence of intraoperative cardiac collapse (2.5% vs. 0%, p = 0.048) and lower ICU admission rates (36% vs. 83%, p < 0.001). The one-year incidences of CTEPH (MT: 3.4% vs. CDT: 4.5%, p=0.49), PE recurrence (4.4 vs 2.5, p=0.31) and all-cause mortality (7.8% vs. 5.8%, p=0.41) were not statistically significant between MT and CDT respectfully.
CONCLUSIONS: In this retrospective cohort, MT and CDT for acute PE showed statistically comparable mortality, CTEPH, and PE recurrence rates at one-year. MT was associated with higher intraoperative cardiac complications, whereas CDT required more frequent ICU admission. Further studies are needed to guide patient selection and optimize treatment strategies.
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