Abstract
Intermediate risk pulmonary embolism (IRPE) is defined as dilatation of the right
ventricular (RV) and evidence of myocardial necrosis with stable hemodynamics in the
setting of acute PE. The differences in performance among the various devices in treating
IRPE remain unclear. We reviewed consecutive patients treated at 2 medical centers
between January 1, 2019, and December 31, 2022, using PMC devices (FlowTriever [Inari
Medical] or Ekos [Boston Scientific]). Demographics, clinical, procedural variables,
in-hospital complications, and 30-day outcomes were recorded from patients' medical
records. Descriptive analyses were performed. The study's primary endpoint was the
mean change in the RV/LV ratio. Safety endpoints included procedural complications
30-day mortality and major bleeding. 97 consecutive patients (43 FlowTriever, 54 Ekos)
were included. The mean age was 64.16 ± 13.37 years. When compared with pretreatment,
PMC reduced significantly the RV/LV ratio (0.55 ± 0.49, 95% CI: 0.40, 0.71, p < 0.0001) and PA pressures (17.98 ± 14.72 mm Hg, 95% CI:10.88, 25.07, p < 0.0001) with no differences seen between the FlowTriever and Ekos. At 30-day, all-cause
mortality and major bleeding were 5.2 and 7.2%, respectively, and were similar between
the FlowTriever and Ekos, respectively (4.7% vs. 5.6% (p = 0.935) and 7.0% vs. 7.4% (p = 0.935)). The Ekos, however, had a shorter procedure time, and less fluoroscopy
and contrast use. PMC devices reduced significantly the RV/LV ratio and PA pressures
when compared with the baseline. No differences were seen between the FlowTriever
and Ekos. Thirty-day mortality and major bleeding were statistically similar between
the two devices.
Keywords
intermediate-risk pulmonary embolus - ultrasound-assisted lysis - mechanical thrombectomy
- major bleeding
