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One Year Outcomes Of Catheter-Directed Thrombolysis And Mechanical Thrombectomy in Acute Pulmonary Embolism
Bright Benfor, MD1, Pallavi Gorantla
2, Sri Achanta
3, Eric K. Peden, MD
1.
1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA,
2University of Texas at Austin, Austin, TX, USA,
3School of Engineering, TAMU, College Station, TX, USA.
OBJECTIVES:This study aimed to compare the one-year outcomes of MT and CDT for acute PE.
METHODS: 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. The primary endpoint was mortality. 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. Patients in the MT group were more likely to have a simplified PE severity index (sPESI) > 0 (73% vs. 60%, p < 0.001). Median procedure duration was longer for MT than CDT ( 66 vs 58 minutes,p = 0.003). Median postoperative LOS 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 overall survival (91.8 vs. 94.1%, p=0.41) were similar in both groups.
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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