Novel innovative catheter-based mechanical thrombectomy in pulmonary embolism and venous thromboembolism: single-center experience

Madan Raj Poudel (Bielefeld)1, D. Lawin (Bielefeld)1, T. Lawrenz (Bielefeld)1, N. B.. Danielsmeier (Bielefeld)1, A. Tego (Bielefeld)1, K. Marx (Bielefeld)1, A. I. Diaconescu (Bielefeld)1, C. Köster (Bielefeld)1, C. Stellbrink (Bielefeld)1

1Universitätsklinikum OWL Klinik für Kardiologie und intern. Intensivmedizin Bielefeld, Deutschland


Background: Venous thromboembolism (VTE) is a frequent acute cardiovascular event associated with substantial in-hospital mortality. Although anticoagulation (AC) and thrombolysis (TL) are standard therapy for intermediate-to-high-risk VTE catheter-based mechanical pulmonary thrombectomy (CBMT) has recently gained interest in the treatment of patients (pts) with insufficient thrombus reduction after AC/TT . There is only limited data available on the safety and efficacy of CBMT. Thus, we evaluated the efficacy and safety of CBMT using the Flow-Triever system (Inari Medical, California, USA) in patients with VTE and PE with an intermediate and high-risk pts.

Methods: We retrospectively analyzed 8 consecutive patients with VTE in our center (age 68± 7.2 years, 50% female) with acute VTE and PE confirmed by computer tomography. 6 pts had massive pulmonary embolism (PE), 1 had thrombotic occlusion of the inferior and 1 of the superior caval vein. Clinical success was defined as improvement in hemodynamic and oxygenation parameters, decrease in pulmonary artery pressure or vessel patency. Furthermore, procedure-related adverse events (device or route access complication, bleeding) were evaluated.

Results: Catheter-based mechanical thrombectomy was successful in all 8 pts. All pat were under effective anticoagulation with heparin. In 6 pats with massive PE, we observed reduction of mean systolic pulmonary artery pressure (sPAP) on average 33.7 mmHg as well as respiratory (oxygen saturation, mean SPO2 7.6% and heart rate (HR) improvement, mean HR reduction 18/min during the Procedure. Echocardiographic parameters of right ventricular (RV) dysfunction (tricuspid annular plane systolic excursion (mean TAPSE increase 2mm / mean sPAP reduction 23mmHg) also improve during the hospital stay. 6 pat got erythrocyte concentrates (EC) during and after the procedure (mean hemoglobin loss 2.3mg/dl and mean transfusion EC 2 pacs). (Mean initial hemoglobin value was 9.3mg/dl) No device-related, vessel access were noted. 1 patient died during the hospital stay after 2 weeks of intervention because of septicemia. The thrombectomy with Flow-Triever system was also successfully performed in both pat. with thrombotic occlusion of the inferior and superior caval vein with significantly improved flow in the CT angiography.

Conclusion: CBMT in intermediate-to-high risk acute VTE was safe and effective in this small single-center series. It may provide a non-pharmacological supplement to AC/TT to establish immediate improvement of hemodynamic and respiratory parameters in this setting. Use of CBMT may be considered in pts refractory to or with contraindications to AC/TT. Prospective-randomized studies are required to establish the effect of CBMT with regard to mortality and morbidity.

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