Document Type

Article

Publication Date

12-2023

Abstract

Background:

Residual pulmonary vascular obstruction (RPVO) following pulmonary embolism (PE) is associated with residual dyspnea, recurrent venous thromboembolism, and chronic thromboembolic pulmonary hypertension. Historically, acute PE treated with anticoagulation alone results in high rates of significant RPVO. Contemporary treatment of submassive PE often involves catheter-based interventions, including mechanical thrombectomy (MT), although their relation to RPVO is not characterized. In this study, we aimed to evaluate the rate of greater than or equal to 10% RPVO in patients treated with MT.

Methods:

Twenty consecutive patients with submassive PE in a single center underwent MT and subsequent planar ventilation/perfusion scintigraphy scan at a median of 4 months after thrombectomy. A quantitative perfusion score was calculated for each planar ventilation/perfusion scintigraphy study to provide a % perfusion defect. Complete hemodynamic data were collected during the procedure and Miller score was calculated using prepulmonary and post-pulmonary angiography. Echocardiographic data were collected prior to, 24 to 48 hours after, and 30 days after the procedure.

Results:

Four of 20 patients (20%) had greater than or equal to10% RPVO at a median of 4 months follow-up. Following MT, the mean Miller score decreased from 24.5 plus/minus 2.9 to 15.8 plus/minus3.3 (P less than .001) and mean pulmonary artery pressure decreased from 36.1 plus/minus 4.8 mm Hg to 26.8 plus/minus 5.4 mm Hg (P less than .001). Right ventricle-to-left ventricle ratio decreased from 1.44 plus/minus 0.2 to 1.05 plus/minus 0.24 by 24 to 48 hours (P less than .001) and 0.85 plus/minus plus/minus 0.1 at 30 days (P less than .001) and right ventricular systolic pressure decreased from 63.2 plus/minus 10 mm Hg to 42.1 plus/minus 9.8 mm Hg at 24 to 48 hours (P less than .001) and 31.9 plus/minus 10.4 at 30 days (P less than .001).

Conclusion:

In this prospective study of patients with submassive PE treated with MT, favorable rates of RPVO were noted in comparison to prior studies of anticoagulation alone along with expected acute hemodynamic and echocardiographic improvements. While this study was small in scope, the results suggest the potential for long-term benefits of MT in acute PE in addition to the acute benefits previously described.


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