Abstract No. 530 Is there a difference in bleeding risk for small-bore versus large-bore mechanical thrombectomy? A systematic review of major complications

Abstract

There are numerous devices that may be used for mechanical thrombectomy. The purpose of this study was to conduct a systematic review of complications with mechanical thrombectomy for pulmonary embolism (PE). A systematic search identified all studies in which patients underwent mechanical thrombectomy for PE. Studies with < 6 patients were excluded. Study details collected included patient demographics, clinical severity (massive vs. submassive), device type and use of intraprocedural tPA for thrombolysis. Major complications were the main outcome measured collected. 26 studies consisting of 462 total patients (221 women and 241 men) with a mean age of 54.0 years were identified. 13 studies had only patients with massive PEs (n = 138), 1 study with only submassive PEs (n = 104), and 12 studies with both massive and submassive PEs (n = 220). 1 Large-bore mechanical thrombectomy study evaluated the 26 Fr AngioVac system and 2 studies used the 20 Fr or greater Inari FlowTriever . The remaining 23 studies were composed of small-bore devices ranging from 6 to 8 Fr, which included AngioJet (n = 11), Aspirex/Rotarex (n = 4), Amplatz Thrombectomy Device (n = 3), Hydrolyser (n = 3) and Indigo (n = 2). 2 studies used intraprocedural tPA (n = 14), 11 studies did not use any tPA (n = 291), and 13 studies used some intraprocedural tPA (n = 157). Subgroup analysis of studies that did not use intraprocedural tPA yielded similar major bleeding rates of 3.2% (5/155) for large-bore thrombectomy and 1.5% (2/136) for small-bore thrombectomy (chi-square statistic 0.9506, P-valueP 0.33) [sic]. Major complication rates were 3.9% (6/155) for large-bore thrombectomy and 2.2% (3/136) for small-bore thrombectomy (chi-square statistic 0.6701, P-valueP 0.41) [sic].Conclusions: There are no randomized controlled trials comparing the multiple mechanical thrombectomy devices for management of PE. This systematic review of available case studies shows that major bleeding and major complication rates for sub-group analysis of large-bore and small-bore thrombectomy devices are low and are comparable.