Catheter-directed versus standard therapy in intermediate–high-risk pulmonary embolism: A retrospective cohort study
Abstract
Background: Interventional techniques for managing acute-phase pulmonary embolism (PE) are under investigation, but their efficacy compared with anticoagulant alone remains uncertain. Aim: To assess the efficacy and safety of catheter-directed interventions (CDI) compared with standard anticoagulation management in patients with intermediate-high-risk pulmonary embolism. Methods: We conducted a large-scale, retrospective, multicentre cohort study of patients hospitalized with intermediate-high-risk PE between 2017 and 2024 in three intensive care units (ICU) and two cardiac ICUs. Patients were stratified based on the use of CDI versus standard anticoagulation. Data on demographics, clinical characteristics and outcomes were collected and analysed. Results: Among 1637 patients admitted for PE, 549 met the inclusion criteria. Of these, 258 patients (47%) received CDI, including 213 (83%) undergoing catheter-directed thrombolysis and 45 (17%) underwent thromboaspiration. The primary composite outcome of in-hospital mortality or systemic thrombolysis was significantly lower in the CDI group versus the standard-treatment group (3.1% vs. 7.2%; P=0.031); multivariable analysis demonstrated a 65% risk reduction (adjusted odds ratio 0.35, 95% confidence interval 0.14-0.80). Minor bleeding events were more frequent with CDI whereas major bleeding complications were similar between groups. Echocardiographic evaluations showed no significant differences in the incidence of pulmonary hypertension, but demonstrated a significant reduction in early and late systolic pulmonary artery pressure in the CDI group. Conclusion: CDI appears to provide potential benefits in the management of intermediate-high-risk PE, including a reduction in the composite outcome of in-hospital mortality or systemic thrombolysis.
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BibTeX
@article{pot2026catheterdirected,
title = {{Catheter-directed versus standard therapy in intermediate–high-risk pulmonary embolism: A retrospective cohort study}},
author = {Louis Pot and Etienne Cassiani-Ingoni and Marc Gainnier and Julien Carvelli and Mohamed Boucekine and Pauline Moyse and Florent Arregle and Octave Cannac and Damien Barrau and Marc Laine and Jennifer Cautela and David Montani and Laurent Bonello},
journal = {Archives of cardiovascular diseases},
year = {2026},
month = sep,
doi = {10.1016/j.acvd.2025.08.014},
url = {https://hal.inrae.fr/hal-05722341v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Catheter-directed versus standard therapy in intermediate–high-risk pulmonary embolism: A retrospective cohort study
AU - Louis Pot
AU - Etienne Cassiani-Ingoni
AU - Marc Gainnier
AU - Julien Carvelli
AU - Mohamed Boucekine
AU - Pauline Moyse
AU - Florent Arregle
AU - Octave Cannac
AU - Damien Barrau
AU - Marc Laine
AU - Jennifer Cautela
AU - David Montani
AU - Laurent Bonello
PY - 2026
DA - 2026/09/02
JO - Archives of cardiovascular diseases
DO - 10.1016/j.acvd.2025.08.014
UR - https://hal.inrae.fr/hal-05722341v1
AB - Background: Interventional techniques for managing acute-phase pulmonary embolism (PE) are under investigation, but their efficacy compared with anticoagulant alone remains uncertain. Aim: To assess the efficacy and safety of catheter-directed interventions (CDI) compared with standard anticoagulation management in patients with intermediate-high-risk pulmonary embolism. Methods: We conducted a large-scale, retrospective, multicentre cohort study of patients hospitalized with intermediate-high-risk PE between 2017 and 2024 in three intensive care units (ICU) and two cardiac ICUs. Patients were stratified based on the use of CDI versus standard anticoagulation. Data on demographics, clinical characteristics and outcomes were collected and analysed. Results: Among 1637 patients admitted for PE, 549 met the inclusion criteria. Of these, 258 patients (47%) received CDI, including 213 (83%) undergoing catheter-directed thrombolysis and 45 (17%) underwent thromboaspiration. The primary composite outcome of in-hospital mortality or systemic thrombolysis was significantly lower in the CDI group versus the standard-treatment group (3.1% vs. 7.2%; P=0.031); multivariable analysis demonstrated a 65% risk reduction (adjusted odds ratio 0.35, 95% confidence interval 0.14-0.80). Minor bleeding events were more frequent with CDI whereas major bleeding complications were similar between groups. Echocardiographic evaluations showed no significant differences in the incidence of pulmonary hypertension, but demonstrated a significant reduction in early and late systolic pulmonary artery pressure in the CDI group. Conclusion: CDI appears to provide potential benefits in the management of intermediate-high-risk PE, including a reduction in the composite outcome of in-hospital mortality or systemic thrombolysis.
SN - 1875-2136
SN - 1875-2128
ER -