Complications Associated with Mechanical Aspiration Thrombectomy for the Treatment of Pulmonary Embolism: A Scoping Review of the Safety Profile

There is substantial literature describing the safety profile of Mechanical Aspiration Thrombectomy (MAT) for Pulmonary Embolism (PE), but no comprehensive summary of the associated complications. This review aims to identify complications related to MAT for intermediate- and high-risk PE.

Materials and Methods:

This review used a scoping method to identify complications of MAT for high- and intermediate-risk PE. Articles were selected using inclusion criteria focusing on English-language studies from PUBMED up to March 6, 2024, that reported data on MAT for PE management. Major bleeding complications (MBCs) and all other complications (AOCs) were the primary outcomes measured. Success was defined by Society of Interventional Radiology (SIR) guidelines {1}. Data analysis was performed using Microsoft Excel and Python, and quality was appraised using the Modified Downs and Black checklist.



Results:

15 studies met the inclusion criteria. 11 were retrospective and 4 prospective studies. 995 total patients (521 men, 474 women) presented with PE (average age 60.2 ± 13.7 years) and were treated with MAT. 778 patients were intermediate risk and 216 were high risk. The overall acute technical and acute procedural/clinical success rates of MAT were 99.1% and 96.8% respectively. From the total 15 studies, nine reported complications from the procedure. The overall reported complications rate was 3.9% (39/995 patients). Major bleeding complications (MBCs) were 0.6% (6/995). All other complications (AOCs) were 3.3% (33/995). Most AOCs were Cardiac arrest/arrhythmia (55%), hemoptysis/pulmonary hemorrhage (24%), deaths (9%). A statistically significant variation in AOC rates was observed across studies (p = 0.0026), though this variation did not affect overall clinical outcomes. From the studies that report the PESI scores of their patient population, 23 patients were seen to have AOCs, and 20 of them had high-risk PESI scores. No statistically significant association between high-risk PESI scores and AOCs (p = 0.462) was identified. Notably, overall complication rates between devices differed, but this was not statistically significant (p = 0.12).



Conclusion:

This study showed that MAT is an effective treatment for PE. However, all other complications other than major bleeding events were significant, with cardiac dysrhythmias being the most frequent. Most complications were manageable without long-term sequelae, and despite these, MAT still possesses a significantly favorable safety profile compared to surgical embolectomy.