The predictive value of Qandali and Miller index scores in patients with intermediate-high- and high-risk pulmonary emboli undergoing aspiration thrombectomy.

Abstract

To evaluate the correlation between clot burden and pulmonary artery pressures, in patients undergoing suction thromboembolectomy for high-risk and intermediate-high risk pulmonary embolism, with secondary outcomes of 30-day morality and ICU length of stay,. IRB exemption was granted for this retrospective study. The charts of 120 consecutive patients who underwent mechanical thromboembolectomy using the Inari FlowTriever system between February 2020 and August 2022 were retrospectively reviewed and the following data collected: pre-procedural BNP and creatinine; echocardiographic findings; pre- and post-procedural pulmonary artery pressures; ICU length of stay; 30-day mortality. Clot burden was scored using Qandali and Miller indices and correlated with the clinical outcomes. Of the 120 patients undergoing thromboembolectomy, pulmonary artery pressures and diagnostic-quality angiograms were available in 109 patients. In the 109 patients with adequate data, Qanadli, pre-Miller and post-Miller scores correlated with pulmonary artery pressures. Neither was independently associated with ICU length of stay. Freedom from 30-day mortality was 91%, and embolism-specific mortality was 92%. All-risk and high-risk patients who survived demonstrated a meaningfully lower pre-Miller and post-Miller score, respectively. Thrombus burden as measured by the Qanadli and Miller scores appear to correlate with pulmonary artery pressures. Furthermore, catheter directed thromboembolectomy leads to a reduction in Miller scores which appears to correlate with a reduction in pulmonary pressures. In high-risk patients, a reduced post-procedural Miller score and pulmonary pressure demonstrated improved 30-day survival. Further investigation between Miller scores and patient mortality is warranted to stratify patients who would benefit from emergent intervention.