Outcomes of catheter-directed embolectomy and surgical embolectomy for intermediate- to high-risk pulmonary embolism: A retrospective observational study

Intermediate risk (IR)- and high risk (HR)-pulmonary embolism (PE) are associated with mortality rates that span 1.8% to 17% and greater than 31% respectively. Catheter-directed embolectomy (CDE) and surgical embolectomy (SE) for IR- and HR-PE offer alternatives to systemic thrombolysis, but data comparing CDE versus SE is limited. We assessed the outcomes of patients with acute PE who received CDE or SE for IR- and HR-PE. A retrospective review of all adult patients who had undergone CDE or SE for IR- and HR-PE in the Mount Sinai Health System between August, 2019 to June, 2022 was performed. Fisher's exact test and Student's t-test (or Mann-Whitney U-test) were used for comparing qualitative and quantitative outcomes respectively between the CDE and SE groups. Fifteen (15) patients received SE, and 25 patients received CDE. Patients who received SE included 53% IR- and 47% HR-PE, while those who received CDE included 60% IR- and 40% HR-PE. CDE and SE had 96% and 100% technical success rates respectively. The 30-day all-cause mortality rates were 13.3% and 8% in the SE and CDE groups respectively (p > 0.05). The rates of major hemorrhagic complications in the CDE and SE groups were 4% and 26.7% respectively (p > 0.05). CDE and SE were associated with high technical success rates in patients with IR- and HR-PE along with a low risk of major complications and acceptable 30-day all-cause mortality rates. In the absence of significant contraindications, CDE may provide a less invasive alternative to SE.