Catheter-directed therapy with the FlowTriever system for intermediate-high and high-risk pulmonary embolism: a single-centre experience

Background Pulmonary embolism is an important cause of preventable mortality. Treatment strategies depend on risk stratification. High-risk patients, and some intermediate-high-risk patients, require urgent reperfusion therapy. Systemic thrombolysis (ST) is the effective first-choice treatment in these patients; however, the high risk of bleeding complications is a major drawback. In this single-centre retrospective cohort study, we report our experience with the FlowTriever thrombosuction system as an alternative or adjunct to ST in intermediate-high and high-risk pulmonary embolism. Methods Demographic and clinical data of all patients treated with the FlowTriever system from December 2021 until March 2024 were retrieved from the electronic medical records. Primary outcomes were technical success rate, 30-day all-cause mortality and major bleeding. Results Twenty-one patients were treated with the FlowTriever system, 14 of whom were considered high risk. The technical success rate was 100%. Thirty-day all-cause mortality was 29% and major bleeding was recorded in 5 patients (24%), of which one bleeding event was related to the FlowTriever procedure. A significant reduction was seen in mean pulmonary arterial pressure and right ventricular end-diastolic dimension. Conclusion In intermediate-high and high-risk pulmonary embolism patients with ST treatment failure or a contraindication for ST, the FlowTriever thrombosuction system seems to be a minimally invasive alternative treatment modality with low complication rates.