Investigating Survival and Clinical Outcomes with Use of Mechanical Thrombectomy in Patients Undergoing Pulmonary Embolism Response Team Consultation

Monday, March 31, 2025

3:36 PM – 3:45 PM CT

Location: Music City Center, 201 AB

Presenting Author(s)

Ryan W. Nolan

Medical Student
University of Nevada, Reno School of Medicine, United States

Author/Co-author(s)

MS

Maanasi Samant, MD

Assistant Professor of Medicine
Washington University School of Medicine in St Louis, United States
Suresh Vedantham, MD (he/him/his)

Professor and Assistant Dean
Mallinckrodt Institute of Radiology, United States
WO

Westley Ohman, MD

Associate Professor of Vascular Surgery and Program Director
Washington University School of Meidicne in St. Louis, United States
ND

Nathan Droz, MD

Assistant Professor, Surgery
University of Utah Health, United States
KS

Kristen Sanfilippo, MD

Associate Professor, Hematology Division
Washington University School of Medicine, United States
Pavan K. Kavali, MD

Associate Professor of Radiology and Surgery
Mallinckrodt Institute of Radiology, United States

Purpose:

In patients with acute pulmonary embolism (PE), we aimed to determine if the use of mechanical thrombectomy (MT) following pulmonary embolism response team (PERT) consultation was associated with higher likelihood of survival and improvement of other short-term outcomes.

Materials and Methods:

This retrospective, single-center study included intermediate-high and high-risk PE patients who received PERT consultation during a 3-year period. Treatment-based cohorts were anticoagulation (AC) alone or MT and anticoagulation (MT+AC). The primary outcome was overall survival during the study period, controlled for comorbidities and known mortality factors. Additional outcomes included in-hospital and 30-day mortality, length of hospital stay, and MT technical success and adverse event rate.

Results:

334 patients were included in this study, 257 of whom received AC alone while 77 received MT+AC. Patients in the MT+AC cohort had a 50.1% improved survival compared to the AC alone cohort (HR=0.499, 95% CI 0.25-0.99, p=0.047). 30-day mortality was 9.1% in the MT+AC cohort (7 of 77) and 17.6% in the AC alone cohort (45 of 257) (p=0.073). In-hospital mortality was 7.8% (6 of 77) in the MT+AC cohort and 13.6% (35 of 257) in the AC alone cohort (p-0.234). MT lowered PE-associated mortality (OR=0.34, 95% CI 0.13-0.90, p=0.036). Patients in the MT+AC cohort had a median length of hospital and ICU stay of 5 days and 2 days compared to 6 days and 3 days in the AC alone cohort (p=0.16 and p=0.29). Technical success rate of MT was 98.7% (76 of 77), with an adverse-event rate of 5.2% (4 of 77).

Conclusion:

Our study demonstrated the additional use of MT to be associated with reduced mortality and a trend of decreased length of hospital and ICU stay in patients with acute intermediate-high or high-risk PE.