Clinical outcomes after catheter-directed therapies for pulmonary embolism in a regional hub-and-spoke system: lessons learned from a real-world experience.

Background And Aims
Pulmonary embolism (PE) is a potentially life-threatening condition requiring timely intervention. This study sought to investigate the short-term outcomes and complications of pharmacomechanical interventions in a regional hub-and-spoke system.Methods
We retrospectively analyzed the first 90 intermediate-high or high-risk PE patients treated with ultrasound-assisted catheter-directed thrombolysis (USAT) and large-bore mechanical thrombectomy (LBMT) following the introduction of a centralized PE response team in our hub-and-spoke regional network.Results
Of the 90 included patients, 71 (78.9%) underwent USAT, 17 (18.9%) LBMT, and 2 (2.2%) both interventional strategies. Median age was 72.0 (60.8-78.2) years and 52.2% were female patients. Echocardiography and lab values revealed signs of right-ventricular impairment, with a baseline right-ventricular/left-ventricular (RV/LV) ratio of 1.2 ± 0.2 and elevated median high-sensitive troponin T [63.0 (37.0-120.0) ng/l] and NT-pro-BNP [2054.5 (538.2-5936.0) pg/ml] pg/ml. The RV/LV ratio was normalized (≤1.0) in 58.2% of cases before hospital discharge. In-hospital mortality occurred in 5 patients (5.6%), while 12 patients (13.5%) experienced bleeding complications, including one fatal intracranial hemorrhage.Conclusion
Our initial experience with pharmacomechanical interventions for intermediate-high/high-risk PE in a regional hub-and-spoke system shows favorable hemodynamic improvements with a nonnegligible complication rate. Optimization of technical aspects and patient selection is necessary.