Equivalent Short Term Venous Stent Patency Rates For Contemporary Mechanical Thrombectomy Devices
Adham N. Abou ALi, MD, Salim Habib, MD, Dana Semaan, MD, Lillian M. Tran, MD, Fanny Alie-Cusson, MD, Karim Salem, MD, Efthymios Avgerinos, MD, Natalie Sridharan, MD.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
OBJECTIVES: Novel mechanical thrombectomy (MT) devices for acute deep venous thrombosis (DVT) have been advocated given their single session capabilities for thrombus removal with decreased need for thrombolytics. Their impact on subsequent iliofemoral stent patency is unknown. Our objective was to evaluate their short-term safety and stent patency outcomes compared to other techniques. METHODS: Patients who underwent stenting for acute iliofemoral DVT between 2007-2020 at a single institution were identified. The interventional approaches were separated into 4 groups: catheter-directed thrombolysis (CDT) alone, CDT and pharmacomechanical thrombolysis (PMT), PMT alone and mechanical thrombectomy (MT) alone. A retrospective review of demographic, operative, and follow-up data was performed. Primary outcomes included 30-day major bleeding (GUSTO severe criteria) and stent patency rates. Chi-square analysis and Kaplan-Meier survival analysis were used to determine outcomes.RESULTS: We identified 145 patients (162 limbs,17 bilateral) who underwent iliofemoral stenting after acute DVT treatment. Mean age was 47.3±17.6 years with 86(59.3%) female. Of those, 89 patients underwent both CDT and PMT, 23 patients underwent CDT alone, 19 patients underwent PMT alone, and 13 patients underwent mechanical thrombectomy alone. The predominant PMT device was the Angiojet (Boston Scientific) (80.5%) compared to the ClotTriever device (Inari) for the mechanical thrombectomy group (84.6%). Intravascular ultrasound (IVUS) utilization was lowest in the PMT group, and highest in the MT alone group (P=.003). Stent type (Wallstent vs. other) and stent extension into the inferior vena cava or below the inguinal ligament were comparable among groups (P>.05) (Table). Technical success was high across all groups (>95%). 30-day venous stent patency rates were comparable among the 4 groups [CDT:100%,CDT and PMT:90.6%,PMT alone:95.7%, MT alone:80.0%;P=.137]. Bleeding events requiring surgical intervention were comparable across groups(P=1.00). Hospital length of stay was similar across groups, however intensive care unit (ICU) length of stay was significantly higher in groups using CDT compared to PMT and MT alone (P=.001) (Table). One-year primary patency rates were comparable across groups (P=.127). CONCLUSIONS: Mechanical thrombectomy devices appear to be safe with lower bleeding rates and ICU hospital days. There appears to be no significant stent patency differences across techniques although longer follow-up periods are needed.
| CDT Alone (n=24 limbs) | CDT and PMT (n=98limbs) | PMT Alone (n=23 limbs) | MT Alone (n=16 limbs) | p-value | |
| Age | 50.2±18.2 | 45.3±16.7 | 50.7±22.2 | 52.4±15.4 | 0.324 |
| Sex (Female) | 56.5% | 58.4% | 68.4% | 53.9% | 0.878 |
| Hypercoagulable State | 8.7% | 20.2% | 5.2% | 30.8% | 0.152 |
| Pre-stent IVUS use | 25.0% | 19.4% | 8.7% | 56.3% | 0.003 |
| Stent Type(Wallstent) | 50.0% | 59.2% | 43.5% | 31.3% | 0.141 |
| Stent into IVC | 25.0% | 22.5% | 30.4% | 15.4% | 0.877 |
| Bleeding requiring interventions | 4.4% | 4.5% | 0% | 0% | 1.00 |
| Lengthof Stay | 4.0±2.7 | 6.2±7.1 | 5.5±3.6 | 2.8±2.2 | 0.161 |
| ICU Lengthof Stay | 1.6±0.9 | 1.5±0.8 | 0.7±1.5 | 0.5±0.7 | 0.001 |
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