OBJECTIVE: Determine superiority of large bore suction thrombectomy (ST) versus catheter directed thrombolysis (CDT) for operative treatment of pulmonary embolism (PE) in patients evaluated by the pulmonary embolism response team (PERT) by comparing clinical and echocardiographic parameters.
METHODS: We performed a retrospective review at a single community hospital between January 1, 2018 and September 1, 2023 to identify all patients with intermediate-high risk saddle or mainstem PE requiring catheter directed intervention, performed by vascular surgeons following PERT protocol. Exclusion criteria included lack of post-operative echocardiogram or simultaneous CDT and ST. Our primary outcomes were time to symptom resolution in patients receiving ST versus CDT. Secondary outcomes included improvement in right ventricular systolic pressure (RVSP), total hospital length of stay, and discharge to home vs rehabilitation.
RESULTS: We identified 51 patients that underwent ST or CDT, of these 17 ST and 28 CDT met inclusion and exclusion criteria. Amongst the included cohort, there were no statistical differences between treatment groups in age, race, vital signs, initial troponin, pre-intervention tricuspid annular plane systolic excursion (TAPSE), RVSP, or right ventricular dysfunction. When comparing ST to CDT, there was a statistically significant reduction in days to symptom resolution (33 with CDT, vs 18.4 with ST, p=0.04) and reduction of RVSP values pre- to post-operatively (-20.3 with ST vs. -11.4 with CDT,, p=0.039). Total hospital length of stay trended toward shorter length of stay for patients who underwent ST (4.9 with ST vs. 6.3 with CDT, p=0.057) and 100% of ST patients were discharged home, compared to 86% (24/28) of CDT patients were discharged to home. Neither of these differences however met statistical significance.
CONCLUSIONS: In patients with PE who undergo PERT evaluation and are found to be candidates for catheter directed intervention, both CDT and ST are proven treatment modalities. However, when compared to catheter directed thrombolysis, patients who undergo large bore suction thrombectomy have a statistically greater reduction in time to symptom resolution, RVSP, and a trend to shorter length of stay and likelihood of going home instead of a rehabilitation center.
