Endovascular treatment of pulmonary embolism: experience from a tertiary center

Intermediate-high and high-risk pulmonary embolism (PE) requires individualized assessment to consider reperfusion strategies. Endovascular techniques—including mechanical thrombectomy, thromboaspiration, and local thrombolysis—have emerged as therapeutic options in experienced centers, aiming to improve pulmonary perfusion and right ventricular function.

To describe the experience of a tertiary center in the endovascular management of PE, including clinical characteristics, techniques employed, and overall hemodynamic evolution.

A retrospective analysis was conducted of 140 consecutive patients diagnosed with PE between [years]. Clinical, echocardiographic, hemodynamic, and procedural variables were collected. Endovascular techniques were applied in selected patients: mechanical thrombectomy (n=29), thromboaspiration (n=12), and local rTPA thrombolysis (n=125). Hemodynamic parameters (pulmonary artery pressure, right atrial pressure, and cardiac output) were measured before the procedure and at 24 hours. Results are presented descriptively without comparison between techniques.

The mean age was 61.5 ± 14.5 years, with a predominance of men (55%) (Table 1). Ninety-two percent of patients were classified as intermediate-high risk and 8% as high risk. The most frequent comorbidities were hypertension (54.3%), diabetes mellitus (17.9%), and active malignancy (12.1%).

Echocardiographically, 91.4% presented a right-to-left ventricular ratio (RV/LV) > 1, and 33.6% showed McConnell’s sign. Among 106 patients with available PESI score, the median class was II. Norepinephrine was required in 8.6% and invasive mechanical ventilation in 3.3%. The most frequently used technique was local thrombolysis (89.3%), followed by mechanical thrombectomy (20.7%) and thromboaspiration (8.6%). The mean time from diagnosis to procedure was 24.6 hours (median 8 hours), with a mean procedure duration of 50.7 minutes and a mean contrast volume of 64 mL. Global hemodynamic analysis showed a reduction in systolic pulmonary artery pressure (from 56.9 to 43.6 mmHg) and mean pulmonary pressure (from 35.9 to 27.2 mmHg). Cardiac output increased overall (from 4.0 to 4.9 L/min) (Figure 1). No major procedure-related complications were recorded.

In this cohort of patients with high-risk PE, endovascular treatment was applied safely and was associated with early hemodynamic improvement. This descriptive analysis reflects the experience of a tertiary center with multiple available techniques. Further studies are warranted to directly compare the efficacy among different endovascular approaches.Table 1:

Basal characteristics