SIR 2024
Venous Interventions
John M. Moriarty, FSIR, MBBS (he/him/his)
Professor
UCLA
Financial relationships: Full list of relationships is listed on the CME information page.
Evans Heithaus, MD
Interventional Radiologist
University of South Florida
Disclosure information not submitted.
Ido Weinberg, MD
Associate Professor of Medicine
Massachusetts General Hospital / Harvard Medical School
Disclosure information not submitted.
David M. Shavelle, MD
Director, Interventional Cardiology
MemorialCare Heart & Vascular Institute
Disclosure information not submitted.
Paul E. Perkowski, MD, RPVI
Associate Professor of Clinical Surgery
Louisiana State University Health Sciences Center
Disclosure information not submitted.
Robert A. Lookstein, MD
Executive Vice Chair; Diagnostic, Molecular, and Interventional Radiology
Mount Sinai Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
This subgroup analysis of the STRIKE-PE study examines the initial perioperative results of 42 patients treated by using Lightning Flash, the newest generation of Computer Assisted Vacuum Thrombectomy (CAVT) with the Indigo Aspiration System (Penumbra Inc).
Materials and Methods:
The STRIKE-PE study is evaluating real-world safety, effectiveness, and long-term functional and quality of life outcomes of first-line endovascular treatment using CAVT for the treatment of PE. This prospective, international, multicenter study will enroll up to 600 patients with acute PE symptoms of ≤14 days and a right ventricle/left ventricle (RV/LV) ratio of ≥0.9.
Lightning Flash uses pressure differential and flow-based algorithms to rapidly detect thrombus vs patent flow. The CAVT technology is designed to optimize rapid thrombus removal while minimizing blood loss.
Results:
The patients had a mean age of 62.5 years, and 54.8% were male. Their PE early mortality risk was intermediate in 90.5% of patients and high in 9.5%.
Median thrombectomy time was 24.5 minutes and median procedure time was 57.0 minutes. Median postprocedure ICU length of stay was 1 day, and 35.7% of patients did not require an ICU stay. One patient (2.4%) experienced a major adverse event within 48 hours (access site hematoma), and no deaths occurred within 30 days. No patients required transfusion; mean estimated blood loss was 321.9 mL.
The mean RV/LV ratio significantly decreased from 1.26 at baseline to 0.90 at 48 hours postprocedure (∆ 27.0%, P < .001). On-table mean systolic pulmonary artery pressure (sPAP) significantly decreased from 50.0 mm Hg before thrombectomy to 30.8 mm Hg after thrombectomy (∆ 23.0%, P < .001). The median Borg dyspnea score significantly decreased from 4.0 (somewhat severe) at baseline to 0.5 (very, very slight) at discharge (∆ 3.0, P < .001).
Conclusion:
In this subgroup of patients treated by using CAVT with Lightning Flash, results are promising with safe and effective thrombus removal achieved efficiently with a median thrombectomy time of under 30 minutes. The ongoing STRIKE-PE study, as well as the STORM-PE trial, will continue to provide insights on CAVT with Lightning Flash for the treatment of PE.