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32. Cardiovascular Nursing
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Catheter-directed therapy for Pulmonary Embolism: A 6-Year experience in a tertiary center
Session:
Sessão de Comunicações Orais 03 – Intervenções avançadas na doença vascular pulmonar e em complicações de dispositivos
Speaker:
Julien Lopes
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Julien Lopes; Daniela Pinheiro; Mariana Caetano Coelho; Bárbara Lacerda Teixeira; André Grazina; João Reis; Pedro Costa; Ana Galrinho; Melanie Ferreira; Pedro Coelho; Rui Cruz Ferreira; Luís Almeida Morais
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Catheter-directed therapies (CDT), including in-situ fibrinolysis and thrombectomy, are increasingly used in the management of pulmonary embolism (PE), particularly in intermediate-high–risk cases. Pulmonary Embolism Response Teams (PERT) have also gained relevance, enabling more coordinated management and multidisciplinary discussion of complex PE presentations. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Aim:</strong> To characterize the PE population referred for invasive percutaneous treatment in a tertiary hospital.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We conducted a prospective registry of consecutive PE patients treated with catheter-directed therapy in a tertiary centre. Baseline data—including demographics, laboratory values, echocardiography, right heart catheterization (RHC), and CT imaging—were collected along with procedural outcomes. A structured follow-up (FU) protocol involving multimodality reassessment at 6 months after the procedure was implemented, and the resulting data were incorporated into the study.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">A total of 156 patients were included, with a mean age of 59.3 ± 16.6 years; 53.5% were female. The mean FU time was 1.3 ± 1.3 years. Thirteen patients were classified as high risk, 142 as intermediate-high risk, and 1 as intermediate-low risk. Regarding CDT modalities, 99 patients underwent in-situ fibrinolysis alone, 34 were treated with FlowTriever thrombectomy, 17 with Penumbra (9 with adjunctive fibrinolysis), 1 with Nautilus, and 5 with EKOS fibrinolysis (Table 1). The mean ICU length of stay was 3 days. Twenty-two patients (14.2%) were suspected of having an acute-on-chronic presentation. During the acute event, mean pulmonary artery pressure was 52.8 ± 14.3 mmHg and mean cardiac index was 2.5 ± 0.6 L/min/m². There were 10 procedural complications, with vascular access complications and major haemorrhage being the most frequent (2.6%). The 30-day mortality rate was 5.8%, and mortality at follow-up was 11.6% (Table 2). A total of 83 patients completed multimodality FU, including echocardiography, RHC, blood analyses, and CT imaging (Table 4).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We describe a sustained increase in our PERT activity, in the percutaneous treatment of PE. Comparing with contemporary literature and risk stratification data, we report a lower 30 day-mortality rate and a lower decompensation rate, in patients submitted to CDT. Moreover, from our prospective registry, a considerably low rate of complications (lower in recent years) is presented, reinforcing the safety profile of our approach. Future PE management should be focused in PERT teams and should include CDT for selected patients. </span></span></p>
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