SIR 2024
Venous Interventions
Ernest N. Barral, B.S. (he/him/his)
Medical Student
Duke School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Jon G. Martin, MD (he/him/his)
Assistant Professor of Radiology
Duke University Medical Center
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Charles Y. Kim, MD, FSIR
Professor and Chief of Interventional Radiology
Duke University
Financial relationships: Full list of relationships is listed on the CME information page.
James Ronald, MD, PhD
Associate Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Waleska Pabon-Ramos, MD, MPH (she/her/hers)
Associate Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Brendan Cline, MD
Assistant Professor of Radiology
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Nicholas T. Befera, MD
Assistant Professor
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Alan Alper Sag, MD
Assistant Professor, Interventional Radiology and Orthopaedic Surgery
Duke University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Paul Suhocki, MD
Associate Professor of Radiology
Duke University Medical Center
Disclosure information not submitted.
Tony P. Smith, MD
Professor of Radiology
Duke University Medical Center
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This study evaluates outcomes for patients with acute massive pulmonary embolism (PE) following first line large bore aspiration thrombectomy (LBAT), focusing on clinical and imaging data.
Materials and Methods:
This single-arm IRB retrospective review includes patients with acute massive PE following first line LBAT from Jan. 2015 to Dec. 2022. An internal procedural database was queried. Inclusion criteria was sustained hypotension or persistent pressor requirement attributed to imaging-confirmed acute PE. Patients with surgical thrombectomy, on active ECMO, or with administration of systemic or local thrombolytics prior to LBAT were excluded. Where available, baseline imaging was compared to patients’ most recent follow-up. Primary outcomes were procedure related complications, 30-day and one-year all cause mortality, and clinical and imaging outcomes. These included intra-procedural pulmonary artery pressure (PAP) changes, heart rate (HR) 72 hours after procedure, RV/LV ratio on CT and RV function on echocardiogram.
Results:
53 patients with massive PE were treated with first line LBAT. All-cause mortality was 15% (n=8) at 30 days and 38% (n=20) at one year. 3 patients expired within 72 hours, excluding them from further analysis. The complication rate was 17% (n=9), including 4 severe adverse events (2 ECMO deployments for PEA arrest or worsening hypotension, 1 cardiac arrest with return of systemic circulation, and 1 intra-procedural mortality). PE recurrence was 5.7% within one year.
43 patients (81%) showed post LBAT improvement in respiratory function and decrease in oxygen requirement. Pre and post LBAT invasive PAPs were documented in 31 cases, with a significant decrease in mean PAP (31.1 +/- 8.2 to 26.3 +/- 8.9; p = 0.015). HR decreased significantly, from 113.1 +/- 20.8 at presentation to 89.1 +/- 17.2 at 72 hours (p < 0.001).
Pre and post RV/LV ratio were measured on CT for 17 patients, with a 23% average decrease (1.47 +/- 0.49 to 1.05 +/- 0.19; p = 0.002). Of 20 patients with pre and post echocardiogram, 18 (90%) showed improvement or normalization of RV function.
Conclusion:
This single-center retrospective review shows promise for LBAT as first line treatment of acute massive PE, with similar mortality rates to other therapeutic modalities and acceptable severe adverse event rates in a high-risk population. Despite limited follow-up data, LBAT was observed to significantly improve RV/LV ratio, reduce intra-procedural mean PAP, and decrease HR. Further studies could benefit from prospective standardized protocols and more consistent clinical and imaging follow-up.