Background:
Intermediate- to high-risk acute pulmonary embolism (PE), defined by right ventricular dysfunction and myocardial injury in the absence of systemic hypotension, is associated with increased early morbidity despite anticoagulation. Systemic thrombolysis is effective in reducing thrombus burden but limited by a relevant risk of major bleeding. Catheter-based thrombectomy has emerged as an alternative reperfusion strategy aiming to improve right ventricular function and hemodynamics without fibrinolytic therapy. We report real-world outcomes of percutaneous pulmonary thrombectomy using the FlowTriever system in a consecutive single-center cohort.
Methods:
We performed a retrospective observational analysis of consecutive patients with acute PE referred for catheter-based thrombectomy between January 2024 and January 2026 at Vivantes Klinikum im Friedrichshain, Berlin. Ninety-eight patients with intermediate- to high-risk PE, defined by a positive simplified Pulmonary Embolism Severity Index (sPESI ≥1) in combination with imaging evidence of right ventricular dysfunction and/or elevated cardiac biomarkers, and without systemic hypotension, were evaluated by a dedicated pulmonary embolism response team. Sixty-nine patients (70%) underwent percutaneous pulmonary thrombectomy, while 29 patients were managed conservatively due to distal thrombus distribution, comorbidities, or patient preference. Clinical, echocardiographic, procedural, and in-hospital outcome parameters were assessed.
Results:
Sixty-nine patients (48% female, mean age 60±16 years) underwent thrombectomy. Use of an adjunctive FlowTriever disc retriever was required in 22% of cases. Acute hemodynamic and respiratory improvements were observed within 60 minutes after intervention. Oxygen saturation increased from 92% to 96% (p=0.043). Right ventricular function improved, with tricuspid annular plane systolic excursion (TAPSE) increasing from 13±3 mm to 21±4 mm (p=0.038). Systolic blood pressure showed a modest increase from baseline values. Mean procedure time was 85±30 minutes, and mean fluoroscopy time was 21±12 minutes. Mean hospital length of stay was 7±3 days, including 2±1 days in the intensive care unit. One procedure-related fatal complication (pulmonary artery perforation) occurred during the study period. No major bleeding or major vascular access complications were observed. Deep vein thrombosis was identified in 46% of patients.
Conclusions:In this real-world single-center cohort of intermediate- to high-risk PE patients, percutaneous pulmonary thrombectomy using the FlowTriever system was associated with rapid improvement in oxygenation and right ventricular function. Procedural safety was favorable, with a low incidence of major complications and no major bleeding events. These findings support catheter-based thrombectomy as a feasible reperfusion strategy in selected patients and underscore the need for prospective controlled studies to further define its clinical impact and optimal patient selection. Limitations include the retrospective design, single-center setting, selection bias, and absence of a comparator arm.
