Outcomes of catheter-directed embolectomy and surgical embolectomy for intermediate- to high-risk pulmonary embolism: a retrospective observational study.

Objective: Intermediate risk (IR)- and high risk (HR)-pulmonary embolism (PE) are associated with mortality rates that span 1.8% to 17% and greater than 31% respectively. Catheter-directed embolectomy (CDE) and surgical embolectomy (SE) for IR- and HR-PE offer alternatives to systemic thrombolysis, but data comparing CDE versus SE is limited. We assessed the outcomes of patients with acute PE who received CDE or SE for IR- and HR-PE.

Methods: A retrospective review of all adult patients who had undergone CDE or SE for IR- and HR-PE in the Mount Sinai Health System between August, 2019 to June, 2022 was performed. Fisher's exact test and Student's t-test (or Mann-Whitney U-test) were used for comparing qualitative and quantitative outcomes respectively between the CDE and SE groups.

Results: Fifteen (15) patients received SE, and 25 patients received CDE. Patients who received SE included 53% IR- and 47% HR-PE, while those who received CDE included 60% IR- and 40% HR-PE. CDE and SE had 96% and 100% technical success rates respectively. The 30-day all-cause mortality rates were 13.3% and 8% in the SE and CDE groups respectively (p > 0.05). The rates of major hemorrhagic complications in the CDE and SE groups were 4% and 26.7% respectively (p > 0.05).

Conclusion: CDE and SE were associated with high technical success rates in patients with IR- and HR-PE along with a low risk of major complications and acceptable 30-day all-cause mortality rates. In the absence of significant contraindications, CDE may provide a less invasive alternative to SE.