Findings from the first international randomized controlled trial to compare patient outcomes following treatment with large-bore mechanical thrombectomy (LBMT) versus catheter-directed thrombolysis (CDT) for intermediate-risk pulmonary embolism (PE) show that LBMT is superior with respect to the hierarchically-tested aggregated outcome of all-cause mortality, intracranial hemorrhage, major bleeding, clinical deterioration and/or escalation to bailout therapy, and postprocedural ICU admission and length of stay. Findings were reported today at TCT 2024 , the annual scientific symposium of the Cardiovascular Research Foundation (CRF). Results are also published in Circulation .
Over the last decade, catheter-based interventions for intermediate- and high-risk PE, including catheter-directed thrombolysis (CDT) and large-bore mechanical thrombectomy (LBMT), have been adopted to avoid the bleeding risks of systemic thrombolysis. Observational studies of CDT and LBMT have separately reported positive outcomes but there are no prior randomized controlled trials directly comparing these two interventional strategies. From February 2022 to February 2024, a total of 550 hemodynamically stable adults with acute PE, right ventricular dysfunction and at least one additional clinical risk factor for adverse outcomes who did not have absolute contraindications to thrombolytics were randomized in a 1:1 allocation to LBMT (n=274) or CDT (n=276).
The trial was conducted at 57 sites in the Uni.