Cardiology Letters 2024, 33(2):91-101

Pulmonary embolism with high risk of early mortality and endovascular treatment

Peter Petruš¹, Matúš Hoferica², Ján Haršány², Andrej Klepanec², Miroslav Bajer³, Daniel Čambál¹

¹ Oddelenie kardiológie, FN Trnava

² Rádiologická klinika, FN Trnava

³ Klinika vnútorného lekárstva, FN Trnava, Slovenská republika

Introduction: Pulmonary embolism is the third most common cardiovascular cause of death. Patients with the highest risk of death are hemodynamically unstable patients who require aggressive reperfusion therapy. Systemic thrombolysis is the most common method of reperfusion therapy used in clinical practice, however, it is associated with high risk of bleeding complications. Surgical embolectomy is another modality of reperfusion therapy, which is associated with significant invasiveness into body. Endovascular treatment options are a relatively new alternative of reperfusion therapy. Endovascular treatment of pulmonary embolism has shown to be safe and effective in several clinical trials. Compared to surgical embolectomy, the method is less invasive and compared to systemic thrombolysis, it is associated with a lower risk of bleeding complications.

Objective: The primary objective of this thesis is to determine the impact of endovascular treatment on the early mortality of patients with high-risk pulmonary embolism.

Methods: This is a retrospective analysis with the inclusion of patients who were hospitalized at the Department of Internal Medicine of Trnava University Hospital with high-risk pulmonary embolism from January 2015 to December 2021. 45 patients were included in the analysis. Patients were divided into two groups. The first group "ATE(-)" included patients hospitalized before endovascular treatment- aspiration thrombectomy was available (January 2015 - June 2018). The second group "ATE(+)" included patients after the implementation of aspiration thrombectomy with the Indigo aspiration system (July 2018 - December 2021). We compared both groups in terms of early mortality.

Conclusion: Aspiration thrombectomy is an effective and safe reperfusion method. With the use of aspiration thrombectomy, we managed to reduce the early mortality of high-risk pulmonary embolism from 38.46% to 18.75%. It´s efficacy was seen especially in patients in whom systemic thrombolysis failed, or was contraindicated.

Keywords: pulmonary embolism; endovascular treatment; aspiration thrombectomy; Indigo; Penumbra

Published: February 1, 2024  Show citation