625 - Outcomes Following Mechanical Thrombectomy, Catheter-Directed Thrombolysis, and Systemic Thrombolysis in Acute Pulmonary Embolism

Purpose: Despite guideline-based treatment options, comparative data on outcomes across treatment modalities for acute pulmonary embolism (PE) remains limited. We aimed to compare 30- and 90-day post-intervention mortality, intensive care unit (ICU) length of stay, and time to physiologic stabilization among patients treated with mechanical thrombectomy (MT), systemic thrombolysis (ST), and catheter-directed thrombolysis (CDT).

Materials and Methods: This retrospective cohort study included adults (18–89 years old) treated for acute PE at two large tertiary care centers in Northeast Florida between January 2010 and January 2025. Patients were identified using diagnosis and procedure codes for MT (e.g., 37184/37185), CDT (e.g., 36014/36015 with same-day lytic administration), or ST (e.g., alteplase or tenecteplase without catheter-based intervention). Patients with major confounding conditions such as sepsis, trauma, systemic malignancy, or recent major surgery were excluded. Extracted data included demographics, comorbidities, lifestyle risk factors, ICU/hospital stay details, vital signs, lab values, and imaging reports. Post-intervention mortality and potential association with comorbidities and risk factors were analyzed using chi-square tests, with Cramer’s V used to assess effect size.

Results: A total of 170 patients were included: MT (n=76), ST (n=69), and CDT (n=25). A significantly greater proportion of MT patients were alive at 90 days post-discharge (68/76 – 89%) compared to CDT (21/25 – 84%) and ST (48/69 – 69.5%) (p< 0.035; Cramer’s V=0.174). Similar trends were seen for 30-day and 90-day mortality: MT (7/76 – 9.2%, 8/76 – 10.5%), CDT (4/25 – 16%, 4/25 – 16%), and ST (20/69 – 29%, 21/69 – 30.4%), with significant differences (p< 0.008 and p< 0.009, respectively) and medium effect sizes (Cramer’s V=0.237 and 0.235). No comorbidities or risk factors were significantly associated with mortality.

Conclusion: Our analysis suggests that MT may offer a reduced risk of death following treatment for acute PE, regardless of comorbidities or other baseline risk factors. These findings support the potential role of MT as a preferred therapy in select patients and may inform future decisions regarding risk stratification, triage, and procedural planning. Ongoing analysis of time to physiological improvement may help clarify which interventions lead to faster recovery and reduced hospital resource utilization.