131 - Percutaneous Thrombectomy in Intermediate and High-Risk Pulmonary Embolism: A Single-Centre Australian Experience

Tam Vo, MBBS – Dr, Flinders Medical Centre; Edward Travers, FRACS (Vasc) – Dr, Flinders Medical Centre; Thavenesh Ramachandren, FRACS (Vasc) – Dr, Flinders Medical Centre; Phillip Puckridge, FRACS (Vasc) – Dr, Flinders Medical Centre; Hani Saeed, FRACS (Vasc) – Dr, Flinders Medical Centre; Nadia Wise, FRACS (Vasc) – Dr, Flinders Medical Centre; Simon Vun, FRACS (Vasc) – Dr, Flinders Medical Centre; Guilherme Pena, FRACS (Vasc) – Dr, Flinders Medical Centre; Chris Delaney, FRACS (Vasc) – Dr, Flinders Medical Centre

Purpose: Acute pulmonary embolism (PE) is associated with an in-hospital mortality of 25% in high-risk patients. Currently, societal guidelines recommend systemic lysis for high-risk PE despite limited data and a major bleeding risk of approximately 10%. Percutaneous thrombectomy has recently been shown to be a promising treatment for intermediate/high risk patients with PE. Here, we review our firsthand experience with this new technique.

Material and Methods: A retrospective review of patients with intermediate or high-risk PE who received percutaneous thrombectomy was conducted. We recorded patient demographics, haemodynamics and pulmonary arterial pressures pre and post intervention. We also considered their peri-procedural recovery including length of hospital stay following intervention.

Results: We treated 44 patients with an average age of 67. Of these patients 24/44 (55%) were male. We identified that 24/44 (55%) of these patients had high risk PE while the remaining patients 20/44 (45%) had intermediate-to-high risk PE according to the European Society of Cardiology guidelines. The Lightning Flash was the most used device in 22/44 (50%) of cases. We also used Indigo CAT8, Lightning 12, Penumbra Flash 2.0, Angiojet and FlowTriever. There was 1 procedural complication (tricuspid regurgitation). All cause in-hospital mortality was 4/44 (9.1%). Only 1 patient was discharged home with an oxygen requirement, with a median length of stay of 7 days post intervention. Of the 9/44 (20.5%) patients who underwent echocardiography pre and post procedure, the mean post-procedural reduction in pulmonary artery pressure was 10mmHg.

Conclusions: The results suggest that percutaneous thrombectomy is safe and effective, and should be considered in the management of patients with intermediate or high-risk PE in an attempt to improve the short-term outcomes in this patient cohort. Further work is required to determine the impact of such therapy on the longer-term sequelae of PE.