TRIple moDality: Extraction,Aspiration and Thrombolysis in Pulmonary Embolism. Preliminary Results of the TRIDENT-PE Study

Abstract

Objective

To evaluate the clinical outcomes and safety of a triple percutaneous treatment protocol involving mechanical thrombolysis, direct thromboaspiration, and low-dose tPA thrombolysis in patients with moderate to high or high-risk pulmonary embolism (PE).

Design

Single-center retrospective cohort study.

Methods

We included patients aged 18 years or older with moderate to high or high-risk PE, as determined by a chest vascular scan. The primary outcome was survival. Secondary outcomes included functional capacity (FC), systolic pulmonary artery pressure (sPAP), right ventricle (RV) dilation, and tricuspid annular plane systolic excursion (TAPSE). All outcomes were assessed at 48-h post-procedure and at the 6-month follow-up. Additionally, the incidence of adverse events was evaluated during the 48-h following the procedure.

Results

Thirty-five patients were included, comprising 51.43% males, with a mean age of 55 years (SD 18). Survival at 48-h post-procedure was 97%. Of the 19 patients who followed up for 6 months, 95% survived. Eight patients (23%) had FC I-II at admission, which increased to 91% at 48-h post-procedure and 100% at 6 months of follow-up. At admission, 25 patients (71%) had moderate to severe RV dilation. In contrast, 33 patients (94%) had a normal or slightly dilated RV at 48-h post-procedure, and 100% (n/N 19/19) at 6 months of follow-up. In addition, there was a significant reduction in mean baseline sPAP to 36 mmHg (SD 10.3) at 48-h post-procedure and to 29 mmHg (SD 4.9) at 6-month follow-up (P < .001). TAPSE increased significantly to 20.8 mm (SD 4.8) at 48-h post-procedure and to 22.3 mm (SD 2.8) at 6-month follow-up (P < .001). No adverse events occurred.

Conclusion

In patients with moderate to high or high-risk PE, the triple percutaneous treatment protocol appears to be an effective and safe intervention. This strategy achieves high survival and adequate FC, normalizing pulmonary vascular pressures and RV function.