Abstract 18534: Catheter-Directed Mechanical Thrombectomy: A PERTinent Paradigm Shift

Abstract

Introduction: The emergence of catheter-directed mechanical thrombectomy (MT) heralded a paradigm shift in the management of pulmonary embolism (PE). There is a paucity of data on the degree to which the availability of this modality has impacted clinical-decision making by the multidisciplinary Pulmonary Embolism Response Team (PERT). We examine data from a single center experience at a large tertiary hospital to shed light. Research Question: How does the recent emergence of MT as a therapeutic strategy impact the approach of a PERT team? Aim: To examine the degree to which the integration of MT into the clinical decision-making algorithm for PE management has impacted the treatment course recommended by a PERT team. Methods: A retrospective analysis was performed to compare PERT recommendations in a contemporary cohort (10/2020-3/2023) to a historical cohort (1/2015-6/2016) prior to the availability of newer generation mechanical thrombectomy catheters in the same institution. Results: The contemporary cohort consisted of 306 patients, of which 50% were treated with advanced therapies including MT, catheter-directed lysis, systemic tPA, or ECMO. In the historical cohort, 28% of patients received advanced therapies. Of those treated with advanced therapies, 84% were MT and 1% were catheter-directed lysis in the contemporary cohort compared to 6% MT and 31% catheter-directed lysis in the historical PERT cohort. Conclusion: The integration of MT into the PERT decision-making process portends a new era in the management of PE. At our center, it significantly expanded the ambit of advanced therapies, such that a majority of patients now receive some form of advanced therapy, rather than anticoagulation alone. This is in stark contrast with the pre-MT era. These findings underscore the importance of a PERT team’s ability to adapt to evolving treatment modalities and highlights the need for continued multidisciplinary expertise in optimizing care for PE patients.