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Catheter-directed Interventions Vs. Surgical Embolectomy In Massive Pulmonary Embolism
Hind Anan, MD1, Pamela EL Hayek, MD
1, Fanny Alie-Cusson, MD
2, Belinda Rivera-Lebron, MD MSCE
1, Elizabeth Andraska, MD MSc
1, Rabih Chaer, MD MSc
1, Marissa Jarosinski, MD
1, Natalie Sridharan, MD MSc
1.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA,
2Atrium Health Cleveland/Carolinas Medical Center, Shelby, NC, USA.
OBJECTIVES: Catheter-directed interventions (CDI) use in massive pulmonary embolism (PE) is rarely studied due to guideline recommendations for systemic thrombolysis (stPA). Nevertheless, surgical embolectomy (SE) and CDI remain well-accepted alternatives in massive PE management, particularly when patients have contraindications to or do not improve after stPA. We hypothesized that CDI and SE have comparable outcomes in the treatment of massive PE.
METHODS: We conducted a retrospective review of patients presenting with massive PE who underwent CDI or SE at a multihospital healthcare system (2010-2024). Baseline characteristics, in-hospital outcomes, and long-term mortality were recorded. Data was analyzed using Kaplan-Meier survival curves and multivariate Cox regression.
RESULTS: A total of 83 patients with massive PE were analyzed, with 26 (31.3%) undergoing SE and 57 (68.7%) receiving CDI (40 suction thrombectomies and 17 catheter-directed thrombolysis). SE and CDI baseline characteristics were similar with median age of 60 years in SE and 66 years in CDI (p=0.077). The majority in both groups had absolute (SE 15.4%, CDI 21.1%;p=0.544) or relative contraindication (SE 69.2%, CDI 63.2%;p=0.590) to stPA. The use of preoperative stPA was similar in both groups (SE 23.1%, CDI 15.8%;p=0.540). Median time to procedure was also similar (SE 18 hours, CDI 11.7;p=0.589). CDI was associated with a lower total intensive care (ICU) length of stay (LOS) (median 92.2 hours vs 64.5;p=0.028), lower hospital LOS (median 10.5 days vs 6.0;p=0.005), and lower major bleeding complications (84.6% vs 12.3%;p<0.001). However, there was no difference in procedure-related bleeding, need for bailout intervention, or resolution of right heart strain between both groups. In-hospital mortality occurred equally (SE 19.2% vs CDI 17.5%;p=1.000). On Kaplan-Meier, there was no survival difference between both groups (Figure-1). On Cox regression, procedure type was not a significant predictor for mortality (adjusted Hazard Ratio [aHR] 0.721; 95%CI 0.291-1.788;p=0.481) while increased age (aHR 1.042; 95%CI 1.003-1.082;p=0.030) and longer time to procedure (aHR 1.011; 95%CI 1.003-1.020;p=0.008) were.
CONCLUSION: CDI is a minimally invasive alternative to SE in massive PE which offers comparable outcomes with similar survival rates. Nevertheless, CDI offers advantages in terms of shorter ICU and hospital stays, as well as fewer major bleeding complications.
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