Exploratory Sub Analysis of Pulmonary Embolism Population Characteristics and Outcomes by Type of Catheter-Directed Thrombolysis in the PEERLESS Randomized Controlled Trial

Monday, March 31, 2025

3:18 PM – 3:27 PM CT

Location: Music City Center, 201 AB

Presenting Author(s)

Carin Gonsalves, MD, FSIR

Professor
Thomas Jefferson University Hospitals, United States

Author/Co-author(s)

WJ

Wissam A. Jaber, MD

Medical Director, Cardiac Cath Lab
Emory University, United States
SS

Stefan Stortecky, MD, MPH

Associate Professor
Bern University Hospital, Switzerland
CG

C Michael Gibson, MD

Interventional Cardiologist
Beth Israel Deaconess Medical Center, United States

Purpose: PEERLESS (NCT05111613) found FlowTriever mechanical thrombectomy (FT; Inari Medical, USA) superior to catheter-directed thrombolysis (CDT; primary endpoint win ratio 5.01, p< 0.01) for treatment of acute intermediate-risk pulmonary embolism (PE). Here we assess if PEERLESS outcomes differed by CDT device type.

Materials and Methods: PEERLESS randomized patients with intermediate-risk PE 1:1 to treatment with CDT or FT.{1} All CDT arm subjects were eligible for this sub analysis, excluding those treated with multiple CDT devices (n=8), non-tPA thrombolytics (n=10), or pharmacomechanical CDT (n=12). Remaining subjects were grouped by device mechanism of action: ultrasound-accelerated CDT (USAT) or multi-sidehole standard CDT (SCDT). Subject and procedure characteristics were compared, as were primary composite endpoint components at discharge or 7 days post procedure.

Results: Eighty-nine percent of CDT subjects (n=246) were included: 159 treated with USAT (Boston Scientific, USA) and 87 with SCDT (72.4% Cragg-McNamara [Medtronic, USA], 24.1% Unifuse [AngioDynamics, USA], 3.4% Fountain [Merit Medical, USA]). Some baseline characteristics differed significantly between USAT and SCDT, including male sex (55.3 vs 39.1%, p=0.02), white race (85.6 vs 63.5%, p< 0.01), mean VTE-BLEED score (1.4 vs 1.8, p=0.03), renal dysfunction (10.7 vs 24.1%, p< 0.01), RV/LV ratio (1.3 vs 1.4, p< 0.01), and right bundle branch block (18.9 vs 5.7%, p< 0.01). There were no differences in all-cause mortality, intracranial hemorrhage, major bleeding, or clinical deterioration and/or bailout between USAT and SCDT (Table 1); however, USAT subjects had significantly lower rates of post-procedure ICU stay > 24 hours (Table 1), median tPA dose (16 vs 22mg, p< 0.01), and median catheter dwell time (10.8 vs 20.1 hours, p< 0.01) than their SCDT counterparts. Rates of serious adverse events were comparable between groups (17.0 vs 17.2%).

Conclusion: Consistent with previous studies,{2,3} clinical outcomes in the PEERLESS trial were similar in intermediate-risk PE subjects treated with USAT and SCDT.