{
  "abstract": "Introduction Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality, with in-hospital mortality reaching up to 65% in patients requiring resuscitation. 1 2 Risk stratification is based on haemodynamic status, Pulmonary Embolism Severity Index (PESI), and markers of right ventricular (RV) dysfunction.3 While anticoagulation and systemic thrombolysis remain standard therapies, catheter-directed treatment (CDT) has been upgraded to a Class IIA recommendation (European Society of Cardiology) due to improved haemodynamics and reduced bleeding risk. We report outcomes of mechanical thrombectomy for acute PE delivered in a District General Hospital (DGH).Methods We analysed 9 consecutive patients treated between September and December 2026 following referral via a multidisciplinary Pulmonary Embolism Response Team (PERT). Mean age was 53 years, with a male predominance. All patients presented with dyspnoea, echocardiographic and biochemical evidence of RV dysfunction. Risk stratification identified 55% as intermediate-high risk and 22% as high-risk PE according to ESC criteria ( table 1). Mechanical thrombectomy was performed using the Inari FlowTriever system via 22G femoral venous access. Standardised pre- and post-procedural assessments included echocardiographic RV and LV function, mean pulmonary artery pressure (mPAP), heart rate, oxygen requirements, functional capacity, major adverse events within 48 hours, length of hospital stay, and 30-day mortality.Results Mechanical thrombectomy resulted in a significant immediate reduction in mPAP from 36.7 mmHg to 20 mmHg (p=0.0014) ( figure 1). Resting heart rate decreased from 113 bpm to 76 bpm (p=0.0008), with successful weaning to room air within 72 hours. Post-procedure transthoracic echocardiography demonstrated rapid RV reverse remodelling with normalisation of tricuspid annular plane systolic excursion and RV strain (figure 2). There were no major bleeding events or access-site complications. One late-presenting case failed due to organised thrombus, yielding an overall procedural success rate of 87%. No major adverse events occurred within 48 hours, and mean length of hospital stay was 5 days.Conclusion Large-bore mechanical thrombectomy is a safe and effective treatment for high-risk and intermediate-high-risk pulmonary embolism, resulting in rapid haemodynamic improvement, reversal of right ventricular dysfunction, and reduced length of hospital stay with low complication rates. These findings are consistent with early prospective trials such as FLARE and EXTRACT-PE, which demonstrated significant reductions in right ventricular-to-left ventricular ratio within 48 hours with very low rates of major bleeding. 4 5 In a DGH setting, our data supports this intervention, in selected patients, as a robust alternative to systemic thrombolysis or as an early intervention for patient whom systemic thrombolysis did not achieve the appropriate haemodynamic stabilisation.Abstract 358 Figure 1Shows improvement mean pulmonary artery pressure post mechanical thrombectomyAbstract 358 Figure 2Shows improvement of right ventricular function with normalising of TAPSE post mechanical thrombectomyAbstract 358 Table 1Baseline demographic and clinical characteristics of the study populationBaseline DemographicsClinical ResultsAge (Mean ± SD)53.0 ± 17.9 yearsPresenting SymptomsDyspnoea (100%), Reduced Exercise Tolerance (100%), Chest Pain (71.4%), Palpitations (71.4%)Risk Stratification (ESC)High Risk: 22%, Intermediate-High: 55%, Intermediate-Low: 11%PESI ScoreClass II (n=2), Class III (n=–), Class IV (n=3), Class V (n=1)BiomarkersPositive troponin in 100% of cases (mean: 208.5 ng/L)Echocardiographic FindingsRV/LV ratio >1.0 (100%), Mean TAPSE 1.39 cmReferences Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med. 2010;363:266–74. doi: 10.1056/NEJMra0907731. [DOI] [PubMed] [Google Scholar]Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 1997;30:1165–71. doi: 10.1016/s0735-1097(97)00319-7. et al. [DOI] [PubMed] [Google Scholar]Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020;41:543–603. doi: 10.1093/eurheartj/ehz405. et al. [DOI] [PubMed] [Google Scholar]Gupta R. Half-dose thrombolysis for intermediate-high risk pulmonary embolism: case series from a London hospital. Eur Respir J. 2019;54:3652. 10.1183/13993003.congress-2019.PA3652Tu T, Toma C, Tapson VF, et al. FLARE study: mechanical thrombectomy for intermediate-risk PE. JACC Cardiovasc Interv. 2019;12:859–869. 10.1016/j.jcin.2019.04.022",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Great Western Hospital, Swindon, United Kingdom"
      ],
      "name": "Ahmed Hussein"
    },
    {
      "affiliations": [
        "Department of Cardiology, Great Western Hospital, Swindon, United Kingdom"
      ],
      "name": "Badrinathan Chandrasekaran"
    },
    {
      "affiliations": [
        "Department of Cardiology, Great Western Hospital, Swindon, United Kingdom"
      ],
      "name": "Paul Foley"
    },
    {
      "affiliations": [
        "Department of Cardiology, Great Western Hospital, Swindon, United Kingdom"
      ],
      "name": "Mustafa Alhassan"
    },
    {
      "affiliations": [
        "Department of Cardiology, Great Western Hospital, Swindon, United Kingdom"
      ],
      "name": "Steve Ramcharitar"
    }
  ],
  "title": "358 Early experiences in the use of mechanical thrombectomy in acute pulmonary embolism management",
  "uid": "5e1519ca-a438-58d2-8426-0186fe684496"
}