Large-Bore Aspiration Thrombectomy versus Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Propensity Score-Matched Comparison

Purpose: To compare effectiveness and safety of large-bore aspiration thrombectomy (LBAT) with catheter-directed thrombolysis (CDT) for treatment of acute massive and submassive pulmonary embolism (PE). Materials and Methods: This retrospective review included patients with acute PE treated with LBAT or CDT using tissue plasminogen activator (tPA) between December 2009 and May 2020. A propensity score based on Pulmonary Embolism Severity Index class and PE severity (massive vs submassive) was calculated, and 26 LBAT cases (age 60.2 y +/- 17.1, 14/26 women) were matched with 26 CDT cases (age 59.7 y +/- 14.2, 14/26 women). Results: The CDT group had 22.1 mg +/- 8.1 tPA infused over 21.2 h +/- 6.6. Both groups demonstrated similar initial and final systolic pulmonary artery pressure (PAP) (LBAT: 54.5 mm Hg +/- 12.9 vs CDT: 54.5 mm Hg +/- 16.3, P =.8, and LBAT: 42.5 mm Hg +/- 14.1 vs CDT: 42.6 mm Hg +/- 12.1, P =.8, respectively) and similar reductions in heart rate (LBAT: -5.4 beats/min +/- 19.2 vs CDT: -9.6 beats/min +/- 15.8, P =.4). CDT demonstrated a higher reduction in Miller score (-10.1 +/- 3.9 vs -7.5 +/- 3.8, P =.02). LBAT resulted in 1 minor hemorrhagic complication and 2 procedure-related mortalities, and CDT resulted in 1 minor and 1 major hemorrhagic complication. Conclusions: LBAT and CDT resulted in similar reductions of PAP and heart rate when used to treat acute PE. CDT reduced thrombus burden to a greater degree. Although hemorrhagic complications rates were not significantly different, the LBAT group demonstrated a higher rate of procedure-related mortality. Larger studies are needed to compare the safety of these techniques.