Background: Patients with intermediate-high or high-risk pulmonary embolism (PE) present with a high morbidity and mortality. Furthermore, they are at high risk for outpatient and in-hospital complications. Ultrasound-assisted, catheter-directed thrombolysis (USAT;EKOS®) and mechanical thrombectomy (FlowTriever®) are emerging interventional therapies which are used in the acute and subacute phase, especially in the event of acute right heart failure. Troponin T (TnT) and NT-proBNP are prognostic relevant markers.
Aim / Purpose: The aim of this retrospective analysis was to evaluate the impact of USAT and MT in intermediate-high or high-risk PE.
Methods: Patients who presented with intermediate-high or high-risk PE between October 2017 and September 2024 and treated with USAT or MT were evaluated retrospectively. Both procedures were performed within 24 hours following hospital admission. Blood serum levels of TnT and NTproBNP were assessed before the intervention and after 24 hours.
Results: 127 patients received interventional treatment. 101 patients were treated using USAT and 26 using MT. TnT levels were reduced in the MT cohort (∆TnT – 25.7 ± 28.7 mmol/l) while in the USAT we could detect an increase (∆TnT + 119 ± 75.7 mmol/l). This aspect didn’t show a statistical significance (p=0.880). While NTproBNP showed a decrease in both cohorts (∆NTproBNP FlowTriever – 2524 ± 1680 pg/ml vs ∆NTproBNP EKOS - 3254 ± 2760), we could detect a stronger effect in the USAT treated patients (p< .001).
Conclusion: Our data suggest that the interventional therapy can rapidly lower blood serum levels of NT-proBNP , especially using USAT. The post interventional raise in TnT levels in USAT need further investigation. Both interventional therapies indicate that a prompt decrease of myocardial stress and injury markers may have a positive e impact on prognosis.
