At the CHEST 2024 conference, a session on managing pulmonary embolism (PE) highlighted research findings on the timing of mechanical thrombectomy for acute pulmonary embolism. The team of researchers includes Dr. Krunal Patel, Pulmonary Critical Care Fellow at Temple University Hospital, Parth Lari, MD, FCCP, Director of the Wellness and Social Media Fellowship, Pulmonary and Critical Care Fellowship, and Associate Professor of Thoracic Medicine. Including. The Department of Surgery at Temple University’s Lewis Katz School of Medicine reviewed data from the FLASH registry, focusing on the efficacy and safety of clot removal devices.
Patel explained that the aim of their study was to investigate whether performing thrombectomy within 12 hours of the onset of symptoms results in better outcomes than later intervention. The findings of this study suggest that early intervention can significantly improve patient hemodynamics and suggest potential new guidelines in the treatment of PE.
This transcript has been lightly edited for clarity.
transcript
What were the highlights of the CHEST session focused on managing pulmonary embolism (PE)?
It was an interesting presentation. So we were actually talking about the FLASH registry database. There was already a recently published data called the FLASH Registry. Therefore, we are currently conducting a general review of the effectiveness of mechanical thrombectomy catheter devices. It was shown to be a relatively safe product with less than 2% side effects and a high level of mortality benefit. What we really wanted to make sure was Dr. (Perth) Lari, who is also one of my mentors and colleagues at Temple University, and I worked with him on early mechanical thrombectomy and late mechanical thrombectomy. I wanted to see if there were any signs.
We know that mechanical thrombectomy is effective. Now I think the next question is not whether it works or whether it’s safe, those answers are relatively answered, but it’s more about timing. For the heart, we know that the door-to-balloon time is about 90 minutes. So, our thought-provoking study is to determine whether we can find a signal to determine whether there is any positive signal for early intervention of less than 12 hours versus slightly delayed intervention of more than 12 hours. It was.
Have there been any interesting findings from studies investigating the impact of rapid mechanical thrombectomy on acute pulmonary embolism outcomes?
Well, I mean, you can imagine that the shorter (interval) group was a little bit sicker. The average time for short intervals (interventions) of 12 hours or less was approximately 6 hours before intervention. The intervention for the longer group then took approximately 24 hours. Despite stratifying the two groups into shorter groups: less than 12 hours and more than 12 hours, the mean was about 6 hours versus about 24 hours. And as you can imagine, the shorter group felt a little worse off.
But even if we take into account their level of acuity and their level of illness to some extent, there is still a greater advantage in their chemical mechanics, their mean pulmonary artery pressure, their systolic pulmonary artery pressure, their 6-minute walk. All tests were averages. Even if you calculate these confounders, it’s much better. It was very interesting. The question arises whether we should intervene sooner rather than later in these patients.
reference
Patel KH, Rali P. Impact of rapid mechanical thrombectomy on outcome of acute pulmonary embolism: insights from the FLASH registry. chest. 2024;166(4):A5837-A5838.
