Mechanical clot disruption during pulmonary thromboembolectomy is safe: A propensity score-matched analysis.

Abstract

Purpose: Aspiration thromboembolectomy is effective for treatment of high and intermediate-high risk pulmonary emboli (PE) but can be challenging when organized thrombus is present. Maceration using an expandable nitinol disk may be useful in these situations, but its safety has not been determined. The purpose of this study was to retrospectively assess the safety of this device when applied in the pulmonary vasculature, using a propensity-score matched group for comparison.

Materials and methods: Inclusion criteria consisted of patients who underwent PE thromboembolectomy within a single healthcare system between December 2020 and December 2022 and subsequently underwent suction thromboembolectomy in which the nitinol disk was used. A comparator group was generated from the remaining patients who underwent conventional PE thromboembolectomy by performing one-to-one propensity-score matching based on age, PE risk category, and sPESI score.

Results: Out of a total of 164 patients who underwent pulmonary thromboembolectomy during the study period, the disk was utilized in 28. The disk was used in the left pulmonary artery in nearly 80 % of patients and in the right pulmonary artery in less than 40 %. Initial, final, and change in mean pulmonary artery pressures were not significantly different between groups. Similarly, mean duration of hospitalization, number of complications, and 30-day mortality rate did not differ.

Conclusion: Use of a nitinol disk during pulmonary thromboembolectomy is safe despite administration of anticoagulation. Clinical effectiveness remains to be determined.