SPC365

Catheter-directed therapies for intermediate-high and high-risk pulmonary embolism: efficacy and safety outcomes from a single-centre cohort

Session: Sessão de Posters 13 - Intervenção coronária avançada: fisiologia, bifurcações e complicações
Speaker: PEDRO CARVALHO MONTEIRO

Congress: CPC 2026
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.4 Interventional Cardiology - Other
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Pedro Monteiro; Bárbara Gonçalves; Tiago Peixoto; Diana Ribeiro; Mariana Pereira Santos; André Alexandre; Gilles Sousa; Maria Trêpa; Raquel Baggen Santos; Bruno Brochado; João Brum Silveira; André Luz

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Introduction: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Acute pulmonary embolism (PE) remains a major cause of cardiovascular mortality. Catheter-directed therapies (CDT) have recently gained relevance in intermediate-high and high-risk PE, particularly when systemic fibrinolysis is contraindicated or ineffective. National evidence remains scarce, and Portugal real-world data are limited.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">We conducted a retrospective single-centre analysis of all patients undergoing CDT for acute PE between January 2019 and October 2025, collecting demographic, clinical, procedural and outcome data.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Forty patients underwent CDT (19 in the last 24 months), with a median age of 63.5 years (IQR 52&ndash;78); 67.5% were women, and the mean Charlson Comorbidity Index was 3.6 &plusmn; 2.8. Overweight (52.5%) and hypertension (50%) were the most prevalent comorbidities; immobilization (30.6%), trauma or major surgery (22.2%) and active cancer (11.1%) were also common risk factors. Twenty-three patients (57.5%) had intermediate-high-risk PE and 17 (42.5%) had high-risk PE. Mean shock index (SI) was 1.06 &plusmn; 0.25, and 38 patients (95%) were classified as high risk for 30-day mortality by the simplified PESI. Right ventricular (RV) dysfunction was present in 36 patients (90%), with a mean TAPSE/PSAP ratio of 0.41 &plusmn; 0.18 mm/mmHg. Twenty-one patients (52.5%) had contraindication to fibrinolysis and eight (20%) had failed prior fibrinolysis. Mechanical thrombectomy was performed in 37 patients (92.5%) and catheter-directed thrombolysis in nine (22.5%). CDT led to early haemodynamic improvement: mean pulmonary artery pressure decreased from 31.3 &plusmn; 8.3 to 28.3 &plusmn; 7.9 mmHg (<em>p</em>=0.005), SI improved to 0.81 &plusmn; 0.19 (<em>p</em>=0.005), and RV dysfunction decreased to 52.5% (<em>p</em>=0.039). One patient in shock died during the procedure, two required mechanical circulatory support, and bleeding occurred in eight patients, including one major bleed; in-hospital mortality was 12.5%. Median follow-up was 12.5 months (IQR 4.8-25.8). No symptomatic recurrent PE occurred; one patient developed chronic thromboembolic pulmonary hypertension and three developed chronic thromboembolic disease without pulmonary hypertension.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Discussion and conclusions: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">In this high-risk cohort, CDT resulted in rapid haemodynamic stabilisation and substantial improvement in RV function, with safety outcomes consistent with published experience. Given the scarcity of national data, this series provides meaningful insight into CDT outcomes in Portugal. CDT appears effective, particularly in elderly patients and in those unsuitable for or failing systemic fibrinolysis.</span></span></span></span></p>