https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 2Universitätsklinikum des Saarlandes Innere Medizin III - Kardiologie, Angiologie und internistische Intensivmedizin Homburg/Saar, Deutschland; 3Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 4Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie Mainz, Deutschland; 5Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 6MVZ CCB Frankfurt und Main-Taunus CCB am Bethanien Krankenhaus Frankfurt am Main, Deutschland; 7Universitätsspital Basel Abt. für Kardiologie Basel, Schweiz
Background: Patients with angiographic signs of chronic thromboembolic pulmonary disease or hypertension (CTEPD/H) are excluded from clinical trials investigating catheter-based treatment for acute pulmonary embolism (PE). As a result, data on safety and efficacy of these therapies are scarce in such patients. Also, the clinical relevance of these angiographic findings, usually without the definite diagnose of CTEPD/H at the time of angiography remains elusive. We aimed to investigate the effects of large-bore mechanical thrombectomy in patients with acute PE and signs of CTEPD/H and to compare them to patients without such signs.
Method: A total of 281 acute pulmonary embolism patients from 5 centers in Germany who underwent large-bore mechanical thrombectomy were included in a pooled analysis. Intraprocedural angiographies were reviewed by two independent investigators and evaluated for the presence of signs of CTEPD/H (CTEPD/H group) or not (non-CTEPD/H-group). These signs include ring-like stenosis, web lesions, subtotal occlusion and chronic total occlusion. Clinical and echocardiographic parameters and safety outcomes as well as measurements during right heart catheterization were compared before and after the procedure between groups.
Results: Signs of CTEPD/H were present in 101 out of 281 patients (36%). Preprocedural pulmonary artery pressure was higher in the CTEPD/H-group (54±14 vs. 48±13 mmHg, p <0.001), while RV/LV-ratio, tricuspid annular peak systolic excursion (TAPSE), respiratory rate, heart rate and arterial pressure did not differ significantly between the two groups.
After the intervention, mean arterial pressure increased significantly in the non-CTEPD/H group (p <0.001) and not significantly in the CTEPD/H-group (p=0.186). Furthermore, we demonstrated a significant reduction of respiratory rate (CTEPH p <0.001, non-CTEPH p <0.001) and heart rate (CTEPH p <0.001, non-CTEPH p <0.001) in both groups, with no significance between both groups (respiratory rate p=0.922, heart rate p=0.590). Systolic pulmonary artery pressure was reduced more in the non-CTEPD/H-group (by 17±8 mmHg, p <0.001) than in the CTEPD/H-group (by 13±9 mmHg, p <0.001, p=0.025 for between-group comparison). Right ventricular to left ventricular ratio was reduced significantly in both groups: In the CTEPH group from 1.16 to 0.87 (p<0.001) and in the non-CTEPH group from 1.28 to 0.95 (p <0.001), however, without any statistical significance between the two groups. Bleeding events, defined as hemoglobin reduction by at least 5 g/dl or transfusion of 2 red cell concentrates, could be documented in 7 CTEPH patients and 18 non-CTEPH patients (p=0.379). A total of 4 (4%) and 16 (9%) Intrahospital deaths (p=0.120) were recorded in the CTEPH and non-CTEPH groups, respectively.
Conclusion: Angiographic signs of CTEPD/H can be found frequently in patients with acute pulmonary embolism. Our data suggest a reduced but yet clinically significant efficacy in terms of pulmonary artery pressure reduction in these patients. Nevertheless, large-bore mechanical thrombectomy was found to be safe and not associated with excess bleeding events or mortality in the CTEPD/H-group.