Technical efficiency, short-term clinical results and safety of a large-bore aspiration catheter in acute pulmonary embolism - A retrospective case study

Junaid T Yasin, Ryan Davis, Arash Saemi, Hariharan Regunath, Armin Krvavac, Sachin S Saboo, Ambarish P Bhat, Junaid T Yasin, Ryan Davis, Arash Saemi, Hariharan Regunath, Armin Krvavac, Sachin S Saboo, Ambarish P Bhat

Abstract

Background: Mechanical thrombectomy plays an important role in the management of acute pulmonary embolism (PE), either when rapid clot dissolution is needed or when thrombolytics are contraindicated. We describe our clinical and technical experience with the FlowTriever mechanical thrombectomy device in patients with acute PE.

Materials and methods: A retrospective analysis was performed on all cases of acute PE treated with the FlowTriever device at a single tertiary care hospital system during the trial period (November 2019-January 2020). Technical and clinical results, including complications, are reported.

Results: Technical success was achieved in all eight successive cases (seven cases of submassive and 1 case of massive PE). Mean pulmonary artery pressure (MPAP) improved significantly after mechanical thrombectomy (27.8 ± 6.4 mmHg preprocedure; 20.5 ± 3.8 mmHg postprocedure; 7.3 ± 5.2 mmHg decrease after the procedure; P = 0.016). Hemoglobin levels did not change significantly after mechanical thrombectomy (11.8 g/dl ± 3.4 preprocedure; 9.9 g/dl ± 2.1 postprocedure; P = 0.20). Reduction in MPAP was achieved in 88% of cases (7/8) and hypoxia improved in all the nonintubated patients (7/7). Mortality observed in one patient with a massive central PE, was not related to the procedure. No mortality or procedural complications were observed in patients with submassive PE.

Conclusions: The positive initial clinical experience and safety profile using the FlowTriever in the treatment of acute PE suggests, it has the potential to fill the unmet needs of a good mechanical thrombectomy device to treat massive and submassive high-risk PE especially when thrombolytics are contraindicated.

Keywords: Chronic thromboembolic pulmonary arterial hypertension; FlowTriever; pulmonary embolism; right heart strain.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
(a and b) Acute bilateral PE. Axial contrast enhanced computed tomography scan showing filling defects (a) in both pulmonary arteries left > right (solid white arrows). The same patient with right heart strain (b) with the right ventricle twice the size of the left (black solid lines)
Figure 2
Figure 2
(a-c) Flowtriever catheter-based mechanical thrombectomy device and its components. Flowtriever (a) is a 20 F catheter which is designed to aspirate clot by creating a vacuum using a proprietary 60 cc syringe (b) attached to a side port. The device also comes with three braided nitinol disks to engage clot and pull it into the aspiration guide catheter (c), as needed in difficult cases with adherent clot. Used with permission of Inari Medical, Irvine CA
Figure 3
Figure 3
(a-c) Thormbectomy with T20. The initial pulmonary angiogram (a) showing a filling defect in right upper pulmonary artery (white arrow) with poor perfusion of the upper lobe. The postthrombectomy angiogram (b) through the T20 (black arrow), showing resolution of the filling defect in the right upper lobe pulmonary artery (white arrow) with good perfusion in the upper lobe. The extracted clot laid out on the procedure table (c)
Figure 4
Figure 4
Change in mean pulmonary artery pressure pre- and post-procedure. Mean pulmonary artery pressure improved significantly after mechanical thrombectomy (27.8 ± 6.4 mmHg prior to procedure; 20.5 ± 3.8 mmHg postprocedure; 7.3 ± 5.2 mmHg decrease after procedure; a 26.3% drop, [P = 0.016])

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