Hart Einar A, Eenhoorn Paul, Nijkeuter Mathilde, Ruigrok Dieuwertje, van der Heijden Joris J, Voskuil Michiel, Liu Tommy K K, Balder Jan Willem, van de Hoef Tim P, van der Harst Pim, Kraaijeveld Adriaan O, Dickinson Michael G
Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
Neth Heart J. 2025 Jan;33(1):14-25. doi: 10.1007/s12471-024-01916-1. Epub 2024 Dec 10.
Pulmonary embolism is an important cause of preventable mortality. Treatment strategies depend on risk stratification. High-risk patients, and some intermediate-high-risk patients, require urgent reperfusion therapy. Systemic thrombolysis (ST) is the effective first-choice treatment in these patients; however, the high risk of bleeding complications is a major drawback. In this single-centre retrospective cohort study, we report our experience with the FlowTriever thrombosuction system as an alternative or adjunct to ST in intermediate-high and high-risk pulmonary embolism.
Demographic and clinical data of all patients treated with the FlowTriever system from December 2021 until March 2024 were retrieved from the electronic medical records. Primary outcomes were technical success rate, 30-day all-cause mortality and major bleeding.
Twenty-one patients were treated with the FlowTriever system, 14 of whom were considered high risk. The technical success rate was 100%. Thirty-day all-cause mortality was 29% and major bleeding was recorded in 5 patients (24%), of which one bleeding event was related to the FlowTriever procedure. A significant reduction was seen in mean pulmonary arterial pressure and right ventricular end-diastolic dimension.
In intermediate-high and high-risk pulmonary embolism patients with ST treatment failure or a contraindication for ST, the FlowTriever thrombosuction system seems to be a minimally invasive alternative treatment modality with low complication rates.
肺栓塞是可预防死亡的重要原因。治疗策略取决于风险分层。高危患者以及部分中高危患者需要紧急再灌注治疗。全身溶栓（ST）是这些患者有效的首选治疗方法；然而，出血并发症的高风险是一个主要缺点。在这项单中心回顾性队列研究中，我们报告了使用FlowTriever血栓抽吸系统作为中高危和高危肺栓塞患者ST替代或辅助治疗的经验。
从电子病历中检索2021年12月至2024年3月期间所有接受FlowTriever系统治疗患者的人口统计学和临床数据。主要结局指标为技术成功率、30天全因死亡率和大出血。
21例患者接受了FlowTriever系统治疗，其中14例被认为是高危患者。技术成功率为100%。30天全因死亡率为29%，5例患者（24%）出现大出血，其中1例出血事件与FlowTriever操作有关。平均肺动脉压和右心室舒张末期内径显著降低。
对于ST治疗失败或有ST禁忌证的中高危和高危肺栓塞患者，FlowTriever血栓抽吸系统似乎是一种并发症发生率低的微创替代治疗方式。
