Management of Acute Pulmonary Embolism in Post Lung Transplant Patients Using Mechanical Thrombectomy and Catheter-Directed Thrombolysis Techniques

Tuesday, April 1, 2025

3:27 PM – 3:36 PM CT

Location: Music City Center, 202 A

Presenting Author(s)

Ahmad Arar, MD

Research Assitant
University of Texas Southwestern, United States

Author/Co-author(s)

SR

Samuel Rice, MD

Assistant Professor
University of Texas, Southwestern, United States
Mhd Wisam Alnablsi, MD

research associate
UTSW Medical Center/Dept of Radiology, United States
Akhilesh Pillai (he/him/his)

Medical Student
McGovern Medical School UTHealth Houston, United States
JB

Jamaal Benjamin, MD

Assistant Professor
UT Southwestern, United States
Rehan Quadri, MD

Assistant Professor
UT Southwestern Medical Center, United States
Rakesh K. Varma, MD

Associate Professor
University of Pittsburgh, United States
Moaz M. Choudhary, MD

Assistant Professor of Radiology
University of Texas Southwestern Medical Center, United States
DL

Daniel Lamus, MD

Assistant Professor
University of Texas Southwestern Medical School Program, United States
Anil K. Pillai, MD, MBA

Professor
University of Texas Health Science Center, United States

Purpose: The outcomes of acute PE are generally worse in lung transplant recipients (LTRs) due to the absence of collateral circulation. There is currently no consensus on the best treatment strategy for these cases. This retrospective study aims to clarify the outcomes of percutaneous mechanical thrombectomy (MT) using the Inari device (Inari Medical, Inc., Irvine, CA) and catheter-directed thrombolysis (CDT) for managing acute PE in LTRs.

Materials and Methods:

9 consecutive LTRs diagnosed with acute PE, confirmed through computed tomography angiography (CTA), were included. All patients had PE affecting either the right or left main pulmonary artery or their major branches supplying the allograft. The median age was 62 years. MT was performed on 6 patients and CDT on 3 patients. Pre- and post- pulmonary artery pressures were documented in both approaches. In 4 patients with DVT above the popliteal vein, confirmed via Doppler US, an IVC filter was inserted during the same procedure. Follow-up evaluations were conducted over 1-3 years after treatment, focusing on various metrics, including ventricular pressures, pulmonary function, CTA results, and lab assessments.

Results:

MT and CDT achieved a technical success rate of 100%, resulting in prompt restoration of pulmonic blood flow. At presentation, 8 patients were hypoxic, and 7 had elevated cardiac biomarker levels. The average Pulmonary Embolism Severity Index score was 130 (MT: 127; CDT: 135). Following intervention, all patients showed improvement. Mean O2 saturation increased from 86% to 96% post procedure. The average mean pulmonary artery (PA) pressure decreased from 25 mmHg before treatment to 18 mmHg afterward, with average reduction of 6.75 mmHg across the cohort—specifically, from 23 to 16 mmHg for MT and from 32 to 24 mmHg for CDT. Two patients with reduced LVEF of 38% and 54% prior to the procedure improved to 60% each. ICU stays were 1 to 5 days for MT and 2 to 4 days for CDT. A comparison was made between follow-up CTAs performed within two months after the procedure and pre-procedure CTAs in seven patients, none of whom showed pulmonary infarction (4 underwent MT, and 3 underwent CDT). One patient who received MT had an initial right lower lobe pulmonary infarct measuring 2.6 x 5.2 x 5.2 cm. Follow-up imaging two months later showed near-complete resolution. The one-year survival rate after treatment was 100%.

Conclusion:

Percutaneous interventions show feasibility and effectiveness in treating acute PE in LTRs. These approaches facilitate quick resolution of thrombus, reduce infarction risk, and are associated with better survival rates.