Improvement in Clinical and Echo Parameters After Aspiration Thrombectomy for Treatment of Acute Pulmonary Embolism

Purpose: To evaluate recovery in patients with acute pulmonary embolism (PE), clinicians rely on clinical parameters and imaging. Right ventricular (RV) size and clot burden are typically evaluated using computed tomography; however, echocardiography has also proven to provide clinically meaningful measures of RV function. This study evaluated improvement in clinical and echocardiography parameters after treating patients with acute PE with computer-aided mechanical aspiration thrombectomy with the Indigo Lightning 12 Aspiration System (Lightning 12, Penumbra).
Materials and Methods: We performed a single-center retrospective review of patients treated with Lightning 12 for acute PE. Clinical and echocardiography parameters were measured before the procedure, 48 hours after the procedure, and at long-term follow-up. The clinical parameters evaluated were abnormal clinical findings of heart rate greater than 110 beats/min, systolic blood pressure less than 100 mm Hg, respiratory rate greater than 30 breaths/min, and oxygen saturation less than 90% on room air. The echocardiography parameters evaluated included pulmonary artery systolic pressure (PASP), RV outflow tract velocity time integral (VTI), left ventricular (LV) outflow tract VTI, RV/LV ratio, acceleration time, VTI/PASP, tricuspid annular plane systolic excursion, and McConnell sign. Safety measures were also evaluated.
Results: This analysis included 101 patients (mean age, 61.9 years; 46.5% female). Nine patients (8.9%) were classified as intermediate low risk; 85 patients (84.2%) as intermediate high risk; and 7 patients (6.9%) as high risk. The median time from symptom onset to procedure was 3.9 days. The median thrombectomy time was 18.3 minutes. Substantial or statistically significant (P < .001) improvement in all clinical and echocardiography parameters occurred from before to after the procedure. The median pulmonary embolism severity index score decreased by 22 points (26.0%) from baseline to 72 hours after then procedure. Procedure-related major bleeding occurred in 1 patient (1.0%). In-hospital death caused by preexisting pneumonia occurred in 3 patients (3.0%). No cases of arrythmia or cardiac complication occurred. At an average of 11.5 months after the procedure, 90.1% (20 of 22) patients had normal RV size and function.
Conclusions: Treatment of patients with acute PE with computer-aided mechanical aspiration thrombectomy rapidly improved clinical and echocardiography parameters. This was accomplished with a short procedure time and an acceptable safety profile.