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Outcomes Of Early Versus Delayed Mechanical Thrombectomy In Acute Pulmonary Embolism
Bright Benfor, MD1, Sri Achanta
2, Pallavi Gorantla
3, Eric K. Peden, MD
1.
1Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA,
2School of Engineering, TAMU, College Station, TX, USA,
3University of Texas at Austin, Austin, TX, USA.
OBJECTIVES:The aim of this study was to evaluate treatment timelines for mechanical thrombectomy in patients with acute PE and to determine impact on clinical outcomes.
METHODS:Retrospective review of all patients receiving mechanical thrombectomy for acute pulmonary embolism in our institution between 2021 and April 2025. Door to needle (DTN) time was defined as the time from emergency room admission to initiation of mechanical thrombectomy. Delayed reperfusion was defined as DTN > 12 hours. Primary endpoint was 30-day mortality.
RESULTS: The median DTN time across our cohort was 17 hours. Delayed MT occurred in 57% of cases. The technical success was 96.7% in early MT and 93.6% in delayed MT (p = 0.095). Delayed reperfusion was associated with a lower reduction in PASP (-11 vs - 15mmHg, p<0.002), and a two-fold increase in 30-day mortality (6.1% vs. 2.5%; p=0.040). There was a numerical trend towards higher one-year survival rate with early MT but did not achieve statistical significance (94.2 vs 91.3%, p=0.39). No statistically significant difference was observed in the incidence of chronic thromboembolic pulmonary hypertension (2.1% vs 4.3%, p-value 0.14) or freedom from PE recurrence at 1 year ( 95.2 vs 95. 3%, p =0.94)
CONCLUSIONS: Delayed mechanical thrombectomy in acute pulmonary embolism is associated with lower PA pressure reduction and an increased risk of 30-day mortality. Strategies targeting treatment delays are warranted to improve overall outcomes. Aditionally, further research is needed to determine the optimal "Door-To-Needle" timing.
Table 1. Treatment timelines in Mechanical Thrombectomy for Acute Pulmonary Embolism| Timeline | Median | IQR |
| Door-to-CTPE, hrs | 2 | [1 - 3] |
| CTPE-to-needle, hrs | 15 | [4 - 25] |
| Door-to-needle, hrs | 17 | [5 - 32] |
| Procedure duration, mins | 66 | [46 - 89] |
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