Suction Mechanical Thrombectomy as Mainstay Treatment for Intermediate-Risk Pulmonary Embolism: A Single-Center Experience

Background
Catheter-based therapies for the management of patients with intermediate-risk pulmonary embolism (PE) are rapidly evolving. Multiple techniques have been used, but data to support the use of one technique over the others are lacking. We report our experience with suction mechanical thrombectomy as the mainstay catheter-directed therapy for the patients with intermediate-risk PE.

Methods
This study retrospectively reviewed 62 patients with intermediate-risk PE treated with the Indigo suction mechanical thrombectomy system (Penumbra, Alameda, California). Forty-four patients (71.0%) received mechanical thrombectomy alone or with a low-dose intrathrombic injection of tissue plasminogen activator (tPA; mean dose, 8.5 mg ± 2.3), and 18 patients (29.0%) received mechanical thrombectomy with additional catheter-directed thrombolysis (mean total tPA dose, 31.3 mg ± 12.4). Pulmonary artery pressure, hemodynamics, and safety outcomes were evaluated.

Results
There were significant improvements in pulmonary artery systolic pressure (60.2 mmHg vs 47.3 mmHg; p < 0.001), heart rate (90 beats/min vs 85 beats/min; p = 0.034), and fraction of inspired oxygen requirement (40% vs 28%; p < 0.001) following the intervention. Clinic follow-up data demonstrated significant improvements in right ventricular diameter (40.9 mm vs 29.3 mm; p < 0.001) and right ventricle-to-left ventricle (RV/LV) ratio (1.08 vs 0.91; p = 0.012) on echocardiogram. Serum hemoglobin had a significant drop (13.0 g/dL vs 11.4 g/dL; p <0.001) following the procedure, but only 2 patients (3.2%) required blood transfusion. There were no intracranial or fatal bleeding events and no device-related complications.

Conclusions
The results of our retrospective review demonstrated that suction mechanical thrombectomy in patients with intermediate-risk PE is a safe and effective treatment.