Eshani J. Choksi, BS
Rowan University School of Osteopathic Medicine
Disclosure(s): No financial relationships to disclose
To compare and evaluate the safety and efficacy of mechanical thrombectomy (MT) and ultrasound-accelerated thrombolysis (USAT) in pulmonary embolism (PE) management by performing a systematic review of the literature.
Materials and Methods:
The PubMed database was searched to identify all pertinent articles on utilization of either Inari’s FlowTriever and Penumbra’s Indigo mechanical thrombectomy devices (Group A) or the Ekos Endovascular system (Group B). A combination of the following search terms was used: “pulmonary embolism,” “mechanical thrombectomy,” “Penumbra,” “Indigo,” “FlowTriever,” “Inari,” “ultrasound-assisted thrombolysis,” “Ekos,” and “EkoSonic.” Outcomes variables analyzed include pre- and post-procedure RV/LV ratio, pre- and post-procedure pulmonary artery pressure, pre-and post-procedure heart rate, pre-and post-procedure oxygen saturation, hospital length of stay, technical success, specific complications, and mortality rate. Statistical analyses of results were conducted using t-test, chi square analysis and adjusted relative risk.
Initial literature search yielded 303 studies, of which 34 studies were included. 16 studies pertained to Group A and 18 studies pertained to Group B. There were 786 patients in Group A and 773 patients in Group B. Group A had a higher average age of patients compared to Group B (61.32 ± 13.35 vs. 59.01 ± 15.34 years, t = 3.17, p < 0.0016). Group B had a higher technical success rate than group A (89.1% vs. 99.3%, χ2 = 60.22, p < 0.0001). Group B had a larger change in mean pulmonary artery pressure (5.31 ± 4.49 vs. 15.93 ± 4.60, t = 39.79, p < 0.0001). Group B had a larger change in heart rate than Group A (18.72 ± 8.28 vs. 27.1 ± 5.23, t = 9.83, p < 0.0001). Group B had a larger change in oxygen saturation compared to Group A (4.87 ± 3.55 vs. 13.79 ± 3.41, t = 12.22, p < 0.0001). Group A had a lower complication rate compared to Group B (2.57% vs. 6.0%, adjusted RR (95% CI): 0.43 (0.26-0.72). There was no statistical difference in change in RV/LV ratio, length of hospital stay or mortality rate between the two groups.
Ultrasound accelerated thrombolysis and percutaneous mechanical thrombectomy are effective therapies for pulmonary embolism with comparable clinical outcomes.