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Outcomes With Hybrid Catheter-Directed Therapy Compared With Aspiration Thrombectomy for Patients With Intermediate-High Risk Pulmonary Embolism

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Intermediate-high-risk pulmonary embolism (IHR PE) is a challenging form of embolism obstruction that causes right ventricular (RV) dysfunction. The optimal management of IHR PE has not been established. This single-center prospective, observational study aimed to evaluate the efficacy and safety of complex catheter-directed therapy (CDT) — catheter-directed mechanical aspiration thrombectomy (CDMT) supplemented with catheter-directed thrombolysis (hybrid CDT) in comparison to CDMT alone for IHR PE.


A propensity score based on the pulmonary embolism severity index class and Miller obstruction index (MOI) was calculated, and 21 hybrid CDT cases (mean age 54.8 (14.7) years, 9/21 women) were matched with 21 CDMT cases (mean age 58.8 (14.9) years, 13/21 women). The baseline demographics, clinical, and treatment characteristics were analyzed.


No significant differences were detected regarding baseline demographics and PE severity parameters. Hybrid CDT demonstrated a higher reduction in mean pulmonary artery pressure (mPAP) (hybrid CDT: median mPAP reduction 8 mmHg (IQR: 6–10 mmHg) vs CDMT: median mPAP reduction 6 mmHg (IQR: 4–7 mmHg); P = 0.019), MOI score (hybrid CDT: median change − 5 points (IQR: 5–6 points) vs CDMT median change − 3 points (IQR: 3–5 points); P = 0.019), and median RV: left ventricular ratio (hybrid CDT: median change 0.4 (IQR: 0.3–0.45) vs CDMT median change 0.26 (IQR: 0.2–0.4); P = 0.007). No major bleeding was observed. Both the hybrid CDT and CDMT alone treatments are safe and effective in managing IHR PE.


Hybrid CDT is a promising technique for the management of IHR PE with insufficient thrombus load reduction by CDMT.

Trial Registration

NCT0447356—registration date 16 July 2020.

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Data Availability

Data are available from the corresponding author upon reasonable request.


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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Sylwia Sławek-Szmyt. The first draft of the manuscript was written by Sylwia Sławek-Szmyt and Aleksander Araszkiewicz, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sylwia Sławek-Szmyt.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Poznan University of Medical Science (09.2019 No. 879).

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Informed consent was obtained from all individual participants included in the study.

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Sławek-Szmyt, S., Araszkiewicz, A., Jankiewicz, S. et al. Outcomes With Hybrid Catheter-Directed Therapy Compared With Aspiration Thrombectomy for Patients With Intermediate-High Risk Pulmonary Embolism. Cardiovasc Drugs Ther (2024).

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