AIMS:

Outcomes of acute pulmonary embolism (PE) remain suboptimal.  Anticoagulation alone results in slow thrombus resolution and leaves patients at risk of decompensation with long lengths of stay. Use of thrombolytics is reserved only for massive PE but incurs a high rate of major bleeding and intracranial haemorrhage. A huge clinical need exists for effective technique to restore perfusion with minimal risk and avoidance of lytic therapy. This report investigates the feasibility and short-term clinical outcomes of patients undergoing suction thrombectomy for acute PE for the first time in Asia.

METHODS AND RESULTS:

A percutaneous large bore suction thrombectomy system was introduced in Asia for the first time in October 2021. Demographics and outcome data of patients undergoing suction pulmonary thrombectomy (SPT) were collected prospectively. 23 consecutive patients (61% male, mean age of 63 years old) underwent SPT at 5 different hospitals in Singapore between November 2021 and July 2022 by the same team of interventional cardiologists. 22 out of 23 patients had ESC intermediate-high risk PE and 1 patient had ESC high risk PE. 3 (13%) patients had failed systemic thrombolysis. In all cases, PE were bilateral. Mean device dwell times and skin-to-skin procedural times were 90.6 ± 31.5 and 133.8 ± 22.5 minutes respectively. Suction thrombectomy was successful in all cases. PA pressure fell from 52/15 mmHg to 36/15 mmHg whilst mean PA pressure decreased from 29.0 ± 6.9 mmHg to 24.5 ± 6.5 mHg (p =0.04) The mean blood loss in the first 10 cases were 250 ± 66.7 mls which decreased to 14.2 ± 9.2 mls in the subsequent 13 cases, with the introduction of a cell saver that allowed for return of micro-filtered blood. There were no procedural related complications. 20 out of 23 patients survived to discharge. There were 3 inpatient deaths unrelated to the intervention. (melioidosis, hypoxic ischaemic encephalopathy due to cardiac arrest with PE and intracranial haemorrhage due to initial heparin therapy for PE) Longer term follow-up data will be presented at the meeting.

CONCLUSION:

Large-bore suction thrombectomy allowed for minimally invasive, safe, effective, bloodless pulmonary reperfusion following the diagnosis of intermediate and high-risk PE. Prompt delivery of pulmonary reperfusion therapies should reduce length of stay and improve long term clinical outcomes of such PE patients.