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.