1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland
Background: In acute pulmonary embolism (PE), catheter-interventional thrombectomy is not recommended for patients with signs of chronic thromboembolic pulmonary disease or hypertension (CTEPD/H), and these patients have been excluded from recent trials on catheter-directed therapies. In contrast to this recommendation, data and research in this area are scarce. We aimed to investigate the effects and safety of large-bore catheter-interventional therapy in patients with PE and signs of CTEPD/H and to compare them to patients without CTEPD/H.
Methods: Patients who underwent aspiration thrombectomy with the FlowTriever Ssystem were retrospectively enrolled from a single center. Clinical and echocardiographic parameters (RV/LV-ratio, systolic pulmonary artery pressure (SPAP) and TAPSE) were compared in patients with suspected signs of CTEPD/H and non-CTEPD/H preprocedural, postprocedural and at least 3 months after discharge.
Results: Of 27 patients (mean age 70 ± 16 years) available for analysis, 9 had signs of CTEPD/H , while 18 were in the non- CTEPD/H group. RV/LV-ratio was significantly reduced in both groups directly after the procedure (in the CTEPD/H group by 0.29±0.30 and in the non- CTEPD/H group by 0.41±0.27, p-value for between the group comparison= 0.32). Very similarly, we observed a significant reduction in SPAP directly after the procedure in both groups ( 19±6.0 mmHg in the CTEPD/H group and 13.99.3 mmHg in the non-CTEPD/H group, p-value for between the group comparison= 0.23 ). SPAP baseline value in the CTEPD/H group was significantly higher than in the non-CTEPD/H group (p-value <0.001). TAPSE did not differ significantly between the groups and was unchanged after the procedure as well as after 3 months. In-hospital death occurred in 1 patient (11%) in the CTEPH-group and in 3 patients (17%) in the non- CTEPD/H group.
After 3 months, all patients in the CTEPD/H group stated a subjective improvement and all could be classified as NYHA I. None of these patients were rehospitalised after being discharged. One patient underwent elective thoracic surgery for pulmonary endarteriectomy.
In the non-CTEPD/H group, one patient did not experience any symptomatic improvement and remained with dyspnea at mild exertion (NYHA III). All other patients in this group had a complete resolution of their symptoms. Rehospitalizations have not been recorded. RV/LV-ration and sPAP remained reduced in both groups in patients with available echocardiography.
Conclusions: Patients with acute pulmonary embolism and signs of CTEPD/H may benefit from catheter-interventional thrombectomy and this method seems to be safe and similarly effective as in patients without signs of CTEPD/H . Long-term effects should still be investigated with a larger data pool, our current evidence suggests an improvement in echocardiographic as well as symptoms of the patients.