Pulmonary embolism (PE) is a critical medical emergency that poses significant morbidity and mortality risk. Though guidelines do not recommend endovascular therapy as an upfront treatment for patients with intermediate‐risk PE due to a lack of adequately powered evidence when compared with standard anticoagulation or systemic fibrinolysis, 1 , 2 there are small studies that show the promise of these techniques. A small retrospective cohort study showed patients with acute PE who received endovascular treatment in addition to medical therapy were more likely to have normalization of right ventricular (RV) dysfunction at 3 to 6 months than those receiving medical therapy alone. 3 The emergence of endovascular treatment as a viable option for restoring hemodynamic stability has invigorated clinical discourse surrounding its efficacy. In this issue of the Journal of the American Heart Association (JAHA), a recent analysis from the multinational STRIKE‐PE (Study of the Long‐Term Safety and Outcomes of Treating Pulmonary Embolism With the Indigo Aspiration System) cohort study, focusing on the effects of computer‐assisted vacuum thrombectomy on RV function, adds valuable data to this evolving landscape. 4
The study offers a snapshot of outcomes from an initial cohort of 300 patients classified by their risk profiles: 5.7% as high risk, 84.7% as intermediate‐high risk, and 9.7% as intermediate‐low risk. These risk stratifications are crucial, as they underline the urgency with which we must act in high‐risk patients, who often experience rapid deterioration. With median thrombectomy times averaging 30 minutes, the efficiency of the computer‐assisted vacuum thrombectomy procedure is commendable, showcasing a potential shift in therapeutic timelines for acute PE management.
Intriguingly, the data reveal a marked reduction in systolic pulmonary artery pressure—from a concerning 51.7 mm Hg to a more manageable 41.3 mm Hg—representing a significant decline of 19.1%. This immediate improvement in pulmonary hemodynamics is a promising indicator of better RV function, particularly relevant in PE, where RV dysfunction often dictates clinical outcomes.
The study's primary effectiveness end point, evaluating the RV/left ventricular ratio, demonstrated substantial improvement. The shift from 1.40 to 0.99 within 48 hours post procedure signifies a 26.8% reduction, an encouraging signal that the hemodynamic burden on the RV is alleviated. Furthermore, clinical parameters, including echocardiographic measures of right heart strain, exhibited comparable enhancements, reinforcing the assertion that timely intervention can reverse pathophysiological changes induced by PE.
Safety remains a paramount concern in any procedural intervention, and the STRIKE‐PE data suggest a low rate of composite major adverse events at just 2.0% within 48 hours post procedure. Such favorable safety margins are critical in persuading clinicians to adopt computer‐assisted vacuum thrombectomy more broadly in their management protocols.
Additionally, patient‐reported outcomes offer a vital glimpse into the procedural benefits. The reduction in the median Borg dyspnea scale score from 4.0 to 0.5 at discharge underscores the marked improvements in patient comfort and quality of life—an essential consideration in the holistic treatment of PE.
As with published results from other endovascular devices, the interim findings from the STRIKE‐PE study spotlight computer‐assisted vacuum thrombectomy as a promising intervention in the therapeutic arsenal against pulmonary embolism. The safe and swift restoration of hemodynamic stability, coupled with significant improvements in RV function and patient‐reported dyspnea, paves the way for further exploration in larger cohorts and longer follow‐ups. Continued investigation and validation of these results with randomized controlled trials comparing to standard medical treatment could herald a paradigm shift in how we approach acute PE management, ultimately improving patient outcomes in this high‐stakes clinical setting. It is therefore incumbent on device manufacturers and investigators to invest in randomized controlled trials to someday make the promise of endovascular therapy for PE as an upfront treatment for certain patient population, at the least, and therefore make endovascular treatment as ready for prime time.
Disclosures
None.
This article was sent to Yen‐Hung Lin, MD, PhD, Associate Editor, for editorial decision and final disposition.
See Article by Moriarty et al.
For Disclosures, see page 2.
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
References
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