First use of large-bore suction thrombectomy for acute pulmonary embolism in Asia-Pacific: feasibility and short-term clinical outcomes

Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic...

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Bibliographic Details
Published in:	Journal of thrombosis and thrombolysis 2023-05, Vol.55 (4), p.660-666
Main Authors:	Kojodjojo, Pipin, Ong, Hean Ann, Loh, Poay Huan, Tay, Edgar, Chang, Peter, Kuntjoro, Ivandito, Low, Ting Ting, Lim, Yinghao
Format:	Article
Language:	eng
Subjects:	Acute Disease Adult Aged Cardiology Clinical outcomes Clinical trials Embolism Feasibility Studies Female Fibrinolytic Agents Heart Hematology Humans Male Medicine Medicine & Public Health Middle Aged Pulmonary Embolism - surgery Pulmonary embolisms Reperfusion Suction - methods Suctioning Thrombectomy - methods Thrombolysis Thrombolytic Therapy - methods Thrombosis Treatment Outcome Venous Thromboembolism - etiology Ventricle
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Summary:	Clinical outcomes for intermediate or high-risk pulmonary emboli (PE) remain sub-optimal, with limited improvements in survival for the past 15 years. Anticoagulation alone results in slow thrombus resolution, persistent right ventricular (RV) dysfunction, patients remaining at risk of haemodynamic decompensation and increased likelihood of incomplete recovery. Thrombolysis elevates risk of major bleeding and is thus reserved for high-risk PE. Thus, a huge clinical need exists for an effective technique to restore pulmonary perfusion with minimal risk and avoidance of lytic therapy. In 2021, large bore suction thrombectomy (ST) was introduced in Asia for the first time and this study assessed the feasibility and short-term outcomes of Asian patients undergoing ST for acute PE. 40 consecutive patients (58% male, mean age of 58.3 ± 16.6 years) with intermediate (87.5%) or high-risk PE (12.5%) were enrolled in this prospective registry. 20% had prior VTE, 42.5% had contraindications to thrombolysis, and 10% failed to respond to thrombolysis. PE was idiopathic in 40%, associated with active cancer in 15% and post-operative status in 12.5%. Procedural time was 124 ± 30 min. Emboli were aspirated in all patients without the need for thrombolytics, resulting in a 21.4% reduction in mean pulmonary arterial pressures and 123% increase TASPE-PASP ratio, a prognostic measure of RV-arterial coupling. (both p
ISSN:	1573-742X 0929-5305 1573-742X