SIR 2024
Arterial Interventions and Peripheral Arterial Disease (PAD)
Adam Fish, MD
Interventional Radiology Resident
Yale University School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Konstantin Gruenwald, MD
Resident Physician
Yale School of Medicine
Disclosure information not submitted.
Joshua Cornmann-Homonoff, MD
Assistant Professor of Radiology and Biomedical Imaging
Yale School of Medicine, Department of Interventional Radiology
Disclosure information not submitted.
To evaluate the correlation between CT and angiographic clot burden, pulmonary artery pressures, and clinical outcomes in patients undergoing suction thromboembolectomy for massive and submassive pulmonary embolism.
Materials and Methods:
IRB exemption was granted for this retrospective study. The charts of 120 consecutive patients who underwent mechanical thromboembolectomy using the Inari FlowTriever system (Inari Medical, Irvine, CA) between February 2020 and August 2022 were retrospectively reviewed and the following data collected: pre-procedural BNP, high-sensitivity troponin T, and creatinine; echocardiographic findings; pre- and post-procedural pulmonary artery pressures; ICU length of stay; 30-day mortality. Clot burden was scored using Qandali and Miller indices and correlated with the clinical outcomes.
Results:
Of the 120 patients undergoing thromboembolectomy, pulmonary artery pressures and diagnostic-quality angiograms were available in 109 patients; in the other 11 patients, right heart pressures were not recorded (7), angiographic images were nondiagnostic (3), or both (1). In the 109 patients with adequate data, post-thrombectomy Miller (post-Miller) scores correlated closely with pulmonary artery pressures (p < < 0.05). There was no correlation with the ICU length of stay. 30-day all-cause mortality was 91%, and embolism-specific mortality was 92%. The average post-Miller score in patients who expired was slightly higher than in those who survived, though this did not reach statistical significance (19.0 vs 16.7, p = 0.09). In patients with massive pulmonary embolism (n = 18), the average post-Miller score was significantly higher in those who expired compared to those who survived (21.5 vs 16.4, p = 0.03).
Conclusion:
Post-procedural Miller scores correlate closely with post-procedural pulmonary artery pressures. Additionally, in patients with massive pulmonary emboli, postoperative Miller scores were significantly higher in patients who expired within 30 days of presentation. Further investigation between postoperative Miller scores and patient mortality is warranted to stratify patients who would benefit from emergent intervention.