368 - Comparative Outcomes of Catheter-Directed Thrombolysis and Mechanical Thrombectomy for Intermediate- and High-Risk Pulmonary Embolism: A National 6-Month Analysis

Wednesday, April 15, 2026

11:51 AM - 12:00 PM ET

Presenting Author(s)

Waseem Wahood, MD, MS

Resident
Jackson Memorial Hospital, University of Miami, United States

Author/Co-author(s)

HH

Hayden Hofmann, BS

Medical Student
Keck School of Medicine of USC, United States
OS

Omar Seyam, BS

Medical Student
Dr. Kiran C. Patel College of Osteopathic Medicine, United States
Deepak Iyer, MD (he/him/his)

Resident Physician
Icahn School of Medicine at Mount Sinai, United States
PM

Peter Monteleone, MD

Assistant Professor of Cardiology
UT Austin Dell School of Medicine, Ascension Texas Cardiovascular, United States
JP

Jonathan Paul, MD

Associate Professor of Cardiology
Department of Interventional Cardiology, University of Chicago, United States
Osman Ahmed, MD, FSIR

Professor of Radiology
University of Utah, United States

Purpose: To compare catheter directed thrombolysis (CDT) and endovascular mechanical thrombectomy (MT) for acute intermediate-risk and high-risk pulmonary embolism (PE) with respect to unplanned 6-month readmissions and in-hospital outcomes using a national database.

Materials and Methods: The NRD was queried from 2016 to 2022 for adult patients with acute nonseptic PE who received either CDT or MT. Inverse probability weighted regression adjustment was used to compare CDT and MT with regards to in-hospital mortality, unplanned 6-month readmissions, discharge other than home(DOTH), total cost as well as gastrointestinal bleeding(GIB), intracranial hemorrhage(ICH), blood transfusion at index admission and 6-month readmission. Results are depicted as average treatment effect(ATE).

Results: A total of 11,038 patients were identified; 9,914(90%) underwent CDT and 1,124(10%) underwent MT. There was a total of 1,461 patients with high risk PE(13.2%). Compared to CDT, the ATE of MT was higher with regards to in-hospital mortality(ATE: 0.007;p=0.048), DOTH(ATE: 0.031;p< 0.001), ICH (ATE: 0.006; p< 0.001), total cost at index admission(ATE: 0.118;p< 0.001), GIB at 6 months (ATE: 0.004; p=0.023), blood transfusions at 6 months (ATE: 0.006; p=0.017) as well as death at final follow-up(ATE: 0.009;p=0.025). The ATE was similar between CDT and MT with regards to GIB(p=0.097) at index admission as well as unplanned 6-month readmission(p=0.10), ICH(p=0.11), and recurrent PE(p=0.39) at 6 months.

Conclusion: MT was associated with higher rates of mortality, DOTH, ICH, and total cost at index admission as well as GIB, blood transfusions and mortality at 6 months. MT was associated with similar rates of GIB at index admission, as well as unplanned readmission, ICH, and recurrent PE at 6 months.