Continuous Aspiration Mechanical Thrombectomy for the management of intermediate- and high-risk pulmonary embolism: Data from the first cohort in Portugal

Rita Calé; Ana Rita Pereira; Filipa Ferreira; Sofia Alegria; Gonçalo Morgado; Cristina Martins; Melanie Ferreira; Ana Gomes; Tiago Judas; Filipe Gonzalez; Corinna Lohmann; Débora Repolho; Pedro Santos; Ernesto Pereira; Maria José Loureiro; Hélder Pereira

doi:10.1016/j.repc.2021.04.009

Continuous Aspiration Mechanical Thrombectomy for the management of intermediate- and high-risk pulmonary embolism: Data from the first cohort in Portugal

Rev Port Cardiol. 2022 Jul;41(7):533-545. doi: 10.1016/j.repc.2021.04.009. Epub 2022 May 27.

[Article in English, Portuguese]

Authors

Rita Calé¹, Ana Rita Pereira², Filipa Ferreira², Sofia Alegria², Gonçalo Morgado², Cristina Martins², Melanie Ferreira³, Ana Gomes³, Tiago Judas³, Filipe Gonzalez⁴, Corinna Lohmann⁴, Débora Repolho², Pedro Santos², Ernesto Pereira⁵, Maria José Loureiro², Hélder Pereira⁶

Affiliations

¹ Cardiology Department, Hospital Garcia de Orta, Almada, Portugal. Electronic address: ritacale@hotmail.com.
² Cardiology Department, Hospital Garcia de Orta, Almada, Portugal.
³ Internal Medicine Department, Hospital Garcia de Orta, Almada, Portugal.
⁴ Intensive Medicine Department, Hospital Garcia de Orta, Almada, Portugal.
⁵ Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisboa, Portugal.
⁶ Cardiology Department, Hospital Garcia de Orta, Almada, Portugal; Faculdade de Medicina de Lisboa, Lisboa, Portugal.

PMID: 36065773
DOI: 10.1016/j.repc.2021.04.009

Abstract

Introduction: This study describes the experience of a reference center using continuous aspiration mechanical thrombectomy for acute high- and intermediate-high-risk pulmonary embolism (PE).

Methods: Twenty-nine consecutive patients with acute central PE (48.3% high-risk PE; 82.8% in class >III from the original Pulmonary Embolism Severity Index score; median Charlson Comorbidity Index of 4) were treated with the Indigo® Mechanical Thrombectomy System between March 2018 and March 2020. Technical success was defined as successful placement of the device and initiation of aspiration thrombectomy. Clinical success was defined as any improvement in hemodynamic and/or oxygenation parameters, pulmonary hypertension or right heart strain at 48 hours, and survival to hospital discharge. Safety was defined as freedom from severe adverse events potentially related to the procedure. Three-month follow-up results were collected.

Results: Technical success was 96.6%. Miller index and systolic pulmonary arterial pressure were significantly reduced after the procedure (-5.5±3.0, and -10.2±11.5 mmHg, respectively, both p<0.001). There was a significant improvement in mean paO₂/FiO₂ ratio (+77.1±103.2; p=0.001), shock index (-0.4±0.4; p<0.001), need for aminergic support at 48 h after the procedure (-75.0%, p=0.006) and improvement in right ventricular function in 66.6% (p=0.008). Clinical success was 75.9%. Severe adverse event rate was 10.3%: two deaths during the procedure and one pulmonary macroembolization during device progression. In-hospital and three-month survival rates were 82.8% and 72.4%, respectively.

Conclusions: Aspiration thrombectomy for acute high- and intermediate-high-risk PE is feasible with a high technical and clinical success rate. Nevertheless, all-cause mortality is still high, probably related to the baseline high-risk features of the studied population and associated comorbidities.

Keywords: Acute pulmonary embolism; Catheter-directed treatment; Embolia pulmonar aguda; Pressão da artéria pulmonar; Pulmonary artery pressure; Thrombectomy; Tratamento dirigido por cateter; Trombectomia.