41 - At the Cutting Edge of Thrombus Treatment: A Comparative Review of Modern Mechanical Thrombectomy Systems

Mina Makary, MD – Associate Professor, Radiology, Ohio State University Wexner Medical Center

Purpose: Acute tissue ischemia secondary to thrombosis, including deep vein thrombosis (DVT), intracranial thrombosis, and pulmonary embolism (PE), represents a leading cause of cardiovascular morbidity and mortality worldwide. Minimally invasive endovascular interventions continue to rapidly evolve with a wide range of therapeutic options. This exhibit aims to review and compare the current technologies available for thrombus management, including catheter-directed thrombolysis (CDT), the JETi hydrodynamic thrombectomy system, Penumbra System, FlowTriever, ClotTriever, and Thrombolex, focusing on their clinical indications, efficacy, and safety profiles.

Material and Methods: A comprehensive review of clinical society guidelines, PubMed-indexed articles, clinical trials, and device registries was conducted to evaluate the use of these technologies in the management of thromboembolism. Key procedure outcome measures included technical success rate, safety (bleeding risk and complications), procedure time, and patient outcomes.

Results: Catheter-directed thrombolysis is a powerful alternative to systemic anticoagulation, particularly in patients at high risk for hemorrhage. Novel mechanical thrombectomy technologies have emerged that offer faster thrombus removal with reduced reliance on thrombolytics. The JETi hydrodynamic thrombectomy system uses a combination of suction and saline jets to fragment and aspirate clots. The Penumbra system delivers atraumatic continuous vacuum without a guidewire. FlowTriever and ClotTriever employ a combination of over-the-wire thrombus aspiration and mechanical engagement without thrombolytics. Thrombolex offers a unique pharmacomechanical system of clot engagement and targeted thrombolytic delivery with minimized systemic exposure. Data from clinical trials suggest that these mechanical systems provide equivalent, if not superior, outcomes to CDT alone, with lower bleeding risks.

Conclusions: The landscape of thrombus management continues to evolve, with innovations in mechanical thrombectomy systems offering more efficient and safer alternatives to traditional systemic anticoagulation. While no single technology has emerged as definitively superior, the range of options expands the pool of patients who can benefit from minimally invasive therapies. Continued research and clinical trials are necessary to further assess the efficacy and outcomes of these technologies.