Background Catheter-based reperfusion therapy is considered an alternative treatment for intermediate to high-risk pulmonary embolism (PE). These therapies can be divided into catheter-directed thrombolysis and catheter-based thrombectomy. High bleeding risk (HBR) were generally excluded from previous studies. Outcomes of these two treatment modalities in patients with high-risk PE are limited. Method This is a single centre retrospective cohort study of patients who were admitted for intermediate to high-risk PE and who were treated with catheter-based interventions due to contraindications for systemic thrombolysis. Baseline demographics, procedural details, clinical outcomes including 30 days PE-related mortality, and bleeding complications including blood transfusion and incidence of ICH were reported. Result 28 patients with acute PE (mean age 58 years) and contraindications for systemic thrombolysis were included in this study, of which 8 (28%) were high-risk. 14 patients (42.9% high and 57.1% intermediate-risk) were treated by aspiration thrombectomy (AT) and 14 (14.3% high and 85.7% intermediate-risk) by ultrasound-assisted catheter-directed thrombolysis (USCDT). There were 3 (10.7%) PE related mortality within 30 days. All of them were high-risk PE and in the USCDT arm. Overall incidence of moderate to severe bleeding was 41.7% (50% in AT and 21.4% in USCDT arm) and most of these patients required blood transfusion. The procedural time were 107.6 minutes for AT and 57.1 minutes for USCDT. Conclusion Catheter-based interventions with either aspiration thrombectomy or ultrasound assisted catheter-directed thrombolysis are viable treatment option for intermediate to high-risk pulmonary embolism in patients with high bleeding risk. Aspiration thrombectomy was associated with lower mortality rate in high-risk patients but higher incidence of blood transfusion and longer procedural time.
Lawrence TH Chan, Chi-Wing Wong, Ho LAM, Yu-Ho Chan, Bryan PY Yan, GuangMing Tan, Outcomes of Catheter-Based Interventions for the Treatment of Intermediate to High-Risk Pulmonary Embolism in Patients With High Bleeding Risk: A Single-Centre Experience Journal of the Hong Kong College of Cardiology 2023;30(3) https://doi.org/10.55503/2790-6744.1504
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