Oral Presentation No. 114 Small-bore aspiration thrombectomy versus catheter-directed thrombolysis in intermediate-high risk acute Pulmonary Embolism

Abstract Introduction Catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT) are treatment options in intermediate-high risk pulmonary embolism (IHRPE). Purpose Compare the efficacy and safety of CDT and MT in IHRPE. Methods Retrospective single-centre study of consecutive IHRPE patients (pts) since 2018, treated with CDT (5Fr Cragg-McNamara device) or MT (Indigo MT system, Penumbra 8Fr). Clinical success at 48h was defined as survival and haemodynamic (HD) stabilization, oxygenation improvement or decrease in pulmonary hypertension (PH)/right heart strain. MACE during follow-up (FUP) was a composite endpoint of cardiovascular mortality, PE recurrence, chronic thromboembolic PH and heart failure hospitalization. Safety endpoint was defined as Major bleeding (BARC3). Results Of 25 pts, 60% were submitted to MT and 40% to CDT. Age (68.6 ± 15.6 vs. 62.7 ± 16.4, P = 0.381), Charlson Comorbidity Index (4.2 ± 1.9 vs. 2.9 ± 2.0, P = 0.121) and PESI score (103.2 ± 40.6 vs. 119.8 ± 46.2, P = 0.410) were similar. MT had increased fluoroscopy time (43.0 ± 19.1 vs. 10.1 ± 6.2 min, P < 0.001) and procedure time (115 ± 63 vs. 45 ± 18 min, P = 0.009). Success at 48 h was similar (80% MT vs. 90% CDT; P = 0.626). Severe adverse events related with the technique happened in 2 pts in MT (1 death, 1 macroembolization) and 1pt in CDT developed HD instability. Haemoglobin fall was higher in MT (1.8 ± 1.3 vs. 0.7 ± 0.8 g/dL, P = 0.018), but BARC3 and transfusion were identical. In-hospital mortality was 8% (2 pts in MT, P = 0.229). Mean FUP was 229 ± 147days, with higher MACE in MT (40% vs. 0%, P = 0.051). Conclusions Despite similar efficacy at short-term, adverse events related to the procedure seemed higher in MT group. CDT was less time consuming.