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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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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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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Contributions

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.

Corresponding author

Correspondence to Sylwia Sławek-Szmyt.

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Ethics Approval

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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The authors affirm that human research participants provided informed consent for the publication of the images in Figs. 1b and c.

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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). https://doi.org/10.1007/s10557-024-07562-4

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