Catheter-directed therapies for patients with acute pulmonary embolism: results from a multiparametric follow-up protocol

Abstract

To the Editor, Anticoagulation alone has proven efficacy for the treatment of low- and low-to-intermediate- -risk acute pulmonary embolism (PE) patients.1 Nonetheless, intermediate-high and high-risk PE are associated with a considerable risk of short-term circulatory collapse, death or chronic thromboembolic pulmonary hypertension, ranging from 3% to 10%, when treated with anticoagulation alone.1 Although systemic fibrinolysis decreases this risk by 50%, this treatment significantly increases the risk of major bleeding, as seen in PEITHO trial (Fibrinolysis for patients with intermediate-risk pulmonary embolism),2 which has limited the use of systemic fibrinolysis to high-risk patients, as recommended in the current guidelines.3 This limitation has led to growing interest in catheter-directed therapies (CDT) for patients with high-risk acute PE and a contraindication or failure of systemic fibrinolysis and patients with intermediate-high risk who develop worsening hemodynamics despite anticoagulation.3 CDT allow faster resolution of perfusion defects and hemodynamic improvement without the systemic hemorrhagic effects of systemic thrombolysis. Despite an increasing use of CDT, the clinical evidence of its benefits remains scarce, as there are no adequately powered randomized controlled trials and current studies have been limited to immediate hemodynamic improvement or imaging surrogate markers.4-6 This study aimed to assess the safety, feasibility, and mid-term effects of CDT. Between 2020...