SIR 2024
Venous Interventions
Ripal Gandhi, MD, FSIR
Attending Physician
Miami Cardiac & Vascular Institute and Miami Cancer Institute
Financial relationships: Full list of relationships is listed on the CME information page.
C Michael Gibson, MD
Interventional Cardiologist
Beth Israel Deaconess Medical Center
Disclosure information not submitted.
Wissam A. Jaber, MD
Medical Director, Cardiac Cath Lab
Emory University
Disclosure information not submitted.
To compare pulmonary embolism (PE) patient outcomes in a large claims database following different types of mechanical thrombectomy (MT) treatment.
Materials and Methods:
Retrospective analysis of all PE encounters with a MT index treatment, from January 2018 through March 2022 in a national all-payer database (PINC AITM Healthcare Data, Premier Inc., Charlotte, NC). In-hospital mortality, discharge to home, and 30-day readmission outcomes were analyzed by therapy type or by device when used as a standalone treatment. Device data were extracted from hospital charge description free-text fields using fuzzy matching and keyword text. Unadjusted and adjusted logistic regression models were constructed to evaluate outcomes by device.
Results:
A total of 5,893 encounters with MT as the only index day PE treatment were identified; an additional 1,812 encounters were found to use MT in combination with another treatment. Forty-one percent of these encounters lacked device-specific information (unspecified MT), 33% used the FlowTriever System (large-bore volume-controlled aspiration MT, Inari Medical, Irvine, CA), 23% the Indigo System (continuous aspiration MT, Penumbra Inc., Alameda, CA), and 3% another MT device. MT use in combination with other treatments varied by device: 13% for large-bore volume-controlled aspiration MT, 23% for unspecified MT, and 39% for continuous aspiration MT.
Adjusted logistic regression modeling of encounters using standalone MT revealed significantly increased odds of in-hospital mortality for patients treated with unspecified MT (OR 1.42 [1.10–1.83], p=.008) or continuous aspiration MT (OR 1.63 [1.21–2.19], p=.001) compared with large-bore volume-controlled aspiration MT. The odds of discharge to home were significantly lower in these same groups (OR 0.84 [0.73–0.96], p=.010, and OR 0.63 [0.53–0.74], p< .001, respectively), but 30-day readmission rates were comparable (OR 1.08 [0.84–1.38], p=.56, and OR 1.20 [0.89–1.62], p=.24, respectively).
Conclusion:
In-hospital mortality, discharge to home, and overall treatment patterns differ significantly by type of MT. Clinical studies directly comparing MT treatments are needed to further understand optimal treatment of PE using MT.