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Impact of Mechanical Thrombectomy Using the FlowTriever System on Hemodynamics and Safety in Acute Pulmonary Embolism
Session:
SESSÃO DE POSTERS 58 – TROMBOEMBOLISMO
Speaker:
Mariana Caetano Coelho
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Mariana Caetano Coelho; Julien Lopes; Bárbara Lacerda Teixeira; André Grazina; João Reis; Ana Galrinho; Duarte Nuno Cacela; Rúben Baptista Ramos; Melanie Ferreira; Ruis Cruz Ferreira; Luís Almeida Morais
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Pulmonary embolism (PE) is the leading preventable cause of death in hospitalized patients. The 2019 ESC guidelines recommend a risk-adjusted approach to acute PE management, stratifying patients by early mortality risk. Low and intermediate-low risk patients are treated with anticoagulation, while high-risk PE may require reperfusion therapy like systemic thrombolysis. However, thrombolysis is underused due to bleeding risks, contraindications, and occasional ineffectiveness. For intermediate-high-risk PE, the bleeding risks outweigh benefits. Catheter-directed reperfusion therapy is an alternative for high-risk cases where thrombolysis fails or is contraindicated. Studies, such as the FLASH trial, show that FlowTriever System (FT) thrombus aspiration is safe and effective for intermediate- and high-risk PE, though data in Portugal remain scarce and there is no follow-up data.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We aim to assess the safety and hemodynamic effects of mechanical thrombectomy using the FT in patients with acute PE with at least intermediate risk, over a six-month follow-up period.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Outcomes: The primary safety outcomes were the number of patients with major adverse events, including major bleeding and periprocedural device- or procedure-related adverse events, between baseline to 48. The efficacy outcomes were changes in pressures measured during right heart catheterization between baseline and six months. Other outcomes included lengths of in-hospital stay, and time spent at intensive care unit (ICU).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">From 2023-2024, 15 patients (mean age 60.3 ± 17.8 years) underwent mechanical thrombectomy using FT. Most patients were at high (20%) and intermediate-high (73.3%) risk, and one (6.7%) in intermediate-low risk, according to the 2019 ESC acute PE guidelines. The majority presented with dyspnea (53%) and syncope (26.6%). The most common risk factors were, in order: history of immobilization (26.6%), active cancer (6.7%), and a history of PE or DVT (6.7%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">At the 6-month follow-up, before thrombectomy, the mean sPAP (58.3 ± 7.7 mmHg) and mPAP (37.0 ± 2.6 mmHg) were severely elevated. After thrombectomy, mean sPAP, diastolic PAP (dPAP), and mPAP decreased by 32 mmHg (95% CI: 2.7 to 61; p = 0.04), 14 mmHg (95% CI: 2.6 to 25.4; p = 0.03), and 17.7 mmHg (95% CI: 7.6 to 27.7; p = 0.02), respectively.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Safety Outcomes: There was only one major access complication, which was a hemorrhage at the femoral access site, between baseline and 48 hours of follow-up. Importantly, one patient died during the 30-day follow-up due to refractory cardiogenic shock.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Conclusion: We present our first experience with an advanced and dedicated large bore device for thrombus aspiration in pulmonary embolism. This device allows a fast retrieve of thrombus, with immediate reduction of right ventricle strain, and long-term reduction of PAP, in high and intermediate high-risk patients, without major safety concerns.</span></span></p>
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