Saleh Hassan, Khaleel Ibrahim, Kerndt Connor, Weber Paul, Hollowell Matthew, McCalmon Connor, Pasion Theresa, Ahmed Mohammad, Habhab Mazin, Rossman Nolan, Parker Jessi, Trethowan Brian, Letourneau Marcel
Division of Cardiology, Department of Heart and Vascular Medicine, Corewell Health West and Michigan State University, Grand Rapids, Michigan.
Michigan State University College of Human Medicine, Grand Rapids, Michigan.
J Soc Cardiovasc Angiogr Interv. 2025 May 1;4(5):102611. doi: 10.1016/j.jscai.2025.102611. eCollection 2025 May.
Pulmonary embolism (PE) is a leading cause of cardiovascular death; little data exist on whether mechanical thrombectomy confers a mortality benefit. Using a retrospective review, 311 consecutive patients with PE who underwent aspiration thrombectomy were compared to 309 propensity score-matched patients with PE treated with anticoagulation alone.
Using a retrospective review, we identified 311 consecutive patients with PE who underwent mechanical thrombectomy along with standard of care; we then identified 1841 patients admitted with a primary diagnosis of PE and used propensity score matching to identify 309 patients with similar pulmonary embolism severity index (PESI) scores and variables. We then evaluated 2-year outcomes between the 2 groups.
Of the 311 patients treated with thrombectomy, 262 were at elevated risk by the European Society of Cardiology (ESC) stratification, 261 had a positive simplified pulmonary embolism severity index (sPESI) and 208 were of PESI class III or higher. Of the 309 patients treated with anticoagulation alone, 261 had elevated risk by ESC stratification, 257 had a positive sPESI, and 201 were PESI class III or higher. When all patients were evaluated, there was a mortality benefit starting at 30 days in patients undergoing thrombectomy; when patients with metastatic cancer were excluded, the mortality benefit was only seen in higher-risk patients. Low-risk patients with or without right ventricular strain had similar mortality whether managed with thrombectomy or anticoagulation alone, with numerically more significant bleeding, stroke, and recurrent pulmonary emboli.
In this single-center, retrospective review, patients with PE who were of ESC high risk and who underwent aspiration thrombectomy with a FlowTriever System (Inari Medical) had a statistically significant reduction in mortality compared to a propensity score-matched group treated with anticoagulation alone; separation in mortality curves continued at 2 years. Our findings also suggest that low-risk patients perform equally well with or without thrombectomy but incur numerically more bleeding events, stroke, and recurrent pulmonary emboli.
肺栓塞（PE）是心血管死亡的主要原因；关于机械血栓切除术是否能带来死亡率益处的数据很少。通过一项回顾性研究，将311例连续接受抽吸血栓切除术的PE患者与309例倾向评分匹配的单纯接受抗凝治疗的PE患者进行比较。
通过回顾性研究，我们确定了311例连续接受机械血栓切除术及标准治疗的PE患者；然后我们确定了1841例以PE为主要诊断入院的患者，并使用倾向评分匹配法确定了309例具有相似肺栓塞严重指数（PESI）评分和变量的患者。然后我们评估了两组之间的2年结局。
在311例接受血栓切除术治疗的患者中，根据欧洲心脏病学会（ESC）分层，262例处于高风险，261例简化肺栓塞严重指数（sPESI）为阳性，208例属于PESI III级或更高。在309例单纯接受抗凝治疗的患者中，根据ESC分层，261例处于高风险，257例sPESI为阳性，201例属于PESI III级或更高。当对所有患者进行评估时，接受血栓切除术的患者在30天时开始有死亡率益处；当排除转移性癌症患者时，死亡率益处仅在高风险患者中可见。无论有无右心室劳损的低风险患者，接受血栓切除术或单纯抗凝治疗的死亡率相似，但在数量上出血、中风和复发性肺栓塞更显著。
在这项单中心回顾性研究中，与倾向评分匹配的单纯接受抗凝治疗的组相比，ESC高风险且使用FlowTriever系统（Inari Medical）接受抽吸血栓切除术的PE患者死亡率有统计学意义的降低；死亡率曲线在2年时仍有差异。我们的研究结果还表明，低风险患者无论是否接受血栓切除术表现相当，但在数量上会发生更多出血事件、中风和复发性肺栓塞。
