Gender and Obesity Are Not Associated with Adverse Outcomes with Endovascular Thrombectomy in Acute Intermediate or High-Risk PE: Single-Center Experience

Cross-sectional reviews of national healthcare data have reported an association between sex and adverse outcomes in relation to percutaneous pulmonary embolism (PE) thrombectomy, but there has as yet not been a single-center review of sex differences in percutaneous thrombectomy outcomes {1}. Additionally, while multiple studies have established body surface area (BSA) as a predictor of surgical outcomes, there is a paucity of data for BSA and pulmonary thrombectomy outcomes {2,3}.

Materials and Methods:

A single-center, retrospective review of acute pulmonary embolism interventions performed between January 2019 and August 2024 was completed comparing large bore aspiration thrombectomy (LBAT), computer-assisted vacuum thrombectomy (CAVT), and ultrasound-assisted thrombolysis. Major adverse events (MAE) were characterized as a cardiac arrest code or death prior to hospital discharge. Patient demographics, procedure details, hospital course to discharge, and length of outpatient follow up were included for comparison.

Results:

149 total patients with acute PE interventions were analyzed. 138 patients underwent aspiration thrombectomy (69M,69F; 64 LBAT, 74 CAVT), of which 36.2% were categorized as massive pulmonary embolism pre-operatively. 21 patients (15.2%) met criteria for major adverse event. Female sex was not associated with an increased rate of adverse events (OR 0.71; 95% CI 0.28-1.82). There was also no significant difference in body surface area (BSA) between adverse events and all thrombectomies. Further, there was no association between BSA and adverse events within each device group (LBAT p=0.88, CAVT p=0.27) or between device groups (p=0.46).

Conclusion:

In a single-center review of patients appropriately selected for percutaneous aspiration thrombectomy through PERT at a large academic center with high-volume operators, no significant difference was seen between sex, BSA, or devices in relation to rates of major adverse events. Historically these groups were considered at higher risk for MAE in acute PE interventions, however these differences may be influenced by operator volume and treatment facility resources. Further studies with larger cohorts at high-volume, large academic centers are needed to establish a true null relation between sex, BSA, and cardiac arrest code or death in relation to percutaneous pulmonary embolism thrombectomy.