“Safety, Efficacy, and Long-term Outcomes of Patients with Severe Pulmonary Hypertension Who Undergo Mechanical Thrombectomy for Pulmonary Embolism: Results from the FLASH Registry” will be presented at SIR 2024 on Monday, March 25 during the 3 p.m. MT Venous interventions; DVT-PE session.
Patients with severe pulmonary hypertension may experience safe, durable results after receiving mechanical thrombectomy (MT) for pulmonary embolism, according to recent data.
Longer-term outcomes following MT for this patient population are not well documented, and though pulmonary embolism has been studied for years, there is still much that physicians don’t understand, said Kenneth H. Cho, MD, MBA, lead author of “Safety, Efficacy, and Long-term Outcomes of Patients with Severe Pulmonary Hypertension Who Undergo Mechanical Thrombectomy for Pulmonary Embolism: Results from the FLASH Registry.”
According to Dr. Cho, many physicians advise that patients with systolic pulmonary artery pressure (sPAP) of greater than 70 mm of mercury should not undergo a large-bore MT treatment.
“To be honest, I have not seen a problem with treating these patients,” Dr. Cho said, adding that he has treated many patients with sPAP greater than 70 mm. Due to his role as a principal investigator for the FLASH registry—a prospective, multicenter registry to study the effectiveness of the FlowTriever System on intermediate and high-risk PE patients—Dr. Cho turned to the large body of data already available for guidance.
“I wanted to find out if patients who presented with pulmonary embolism along with extremely elevated pulmonary artery pressures had worse outcomes from mechanical thrombectomy,” he said. “I wanted to see if it was more dangerous to do procedures on these patients and how they did in the long run—to see if they did better, worse or the same as patients who were not as severe in their pulmonary artery pressures.”
Dr. Cho identified 99 patients from the FLASH registry who met sPAP criteria; 92 (92.9%) had intermediate-risk PE, and 7 (7.1%) had high-risk PE. Following MT, their average sPAP decreased from 78.9 to 60.9 mmHg. In addition, Dr. Cho looked at adverse event rates and durability.
“These patients did not have a significantly higher risk of major adverse event. They also did not have any increase in procedure-related mortality or even all-cause mortality,” Dr. Cho said. “The only thing we found was that at 6 months, these patients had a higher incidence of chronic thromboembolic pulmonary hypertension, but it was still a relatively low percentage—4%.”
Though these data have helped Dr. Cho better understand pulmonary embolism and the disease process, as well as patient safety, he does urge caution when treating this patient population.
“Patients with extremely elevated pulmonary artery pressures are very sick and are high risk,” he said. “Even though our data suggest that MT is safe and has good outcomes even in patients with elevated pulmonary artery pressures, that doesn't mean MT should be performed indiscriminately. More research is needed to validate in which patients intervention to include MT is appropriate.”
Rather, Dr. Cho hopes these data can help physicians feel more confident about safety outcomes and encourage them to consider that extremely high pulmonary artery pressure should not immediately disqualify a patient from a life-saving procedure.
“I think that we need to be critical of what we have always taken for granted,” he said. “Just because we've always done something or always believed something doesn’t mean we can’t periodically take a fresh look at those rules and make sure it’s still good guidance.”
