Procedural duration and door-to-procedure time in patients receiving large-bore percutaneous thrombectomy for acute pulmonary embolism

Abstract Background Large-bore mechanical thrombectomy (LBMT) has emerged as an effective and safe therapy option for deteriorating patients with intermediate- or high-risk pulmonary embolism (PE). We aimed to evaluate the procedural duration and door-to-procedure time in patients receiving LMBT. Methods We retrospectively included consecutive patients with intermediate- or high-risk PE treated with LBMT (FlowTriever® system, INARI Medical) in a Clinic and a University Medical Center from March 2022 to May 2025. We investigated the procedural duration and door-to-procedure time in terms of their predictors and how they related with clinical and procedural outcomes. Results A total of 101 patients (median age 60 years, 43% women) were included; 31% were diagnosed with high-risk PE, while the rest with intermediate-risk PE. Baseline characteristics and clinical presentation are presented in Table 1. Procedural duration was 105 minutes (interquartile range [IQR] 71-137 minutes), while median door-to-procedure time was 130 minutes (IQR 88-411 minutes). Neither procedural duration nor door-to-procedure time was different between high- and intermediate-risk patients after multivariable adjustment. Door-to-procedure time was 94 minutes (IQR 75-120 minutes) in patients with catecholamines, 100 minutes (IQR 70.8-163 minutes) in patients presenting with cardiac arrest, and 138 minutes (IQR 98.5-214 minutes) in patients requiring pre-ECMO implantation. Procedural duration significantly shortened with each cumulative procedure (-1.91 minutes, 95% confidence interval [CI], -2.84 – -0.97 minutes, p<0.001) with a multivariable adjustment, while allowing the intercept to differ by center. No such effect of cumulative procedure was observed for the door-to-procedure time. In-hospital death occurred in nine individuals (8.9%), while the composite clinical endpoint of death, PE recurrence or clinical deterioration in 19 (18.8%). Door-to-procedure time was significantly longer in patients surviving hospital stay, while there was no interaction with the PE risk stratification. Technical failure was observed in eight patients (7.9%). There was no association between technical failure of LBMT and procedural duration. Conclusion Large-bore mechanical thrombectomy for intermediate- and high-risk pulmonary embolism showed improvement in procedural efficiency with increasing experience, but not in door-to-procedure time. Procedural and door-to-procedure times were not associated with technical failure or adverse clinical outcomes.Table 1 Figure 1