Large-bore Mechanical Thrombectomy for Treatment of Intermediate-high Risk Pulmonary Embolism: A Single-center Australian Experience.
7 affiliations
- 1Interventional Radiology Service, Northern Imaging Victoria, Northern Health, Australia.
- 2Northern Clinical Diagnostics and Thrombovascular Research (NECTAR) Group, Northern Health, Australia.
- 3Department of Medicine - Northern Health, University of Melbourne, Australia.
- 4Department of Haematology, Northern Pathology Victoria, Northern Health, Australia.
- 5Australian Centre for Blood Diseases, Monash University Australia.
- 6School of Health and Biomedical Sciences, RMIT University, Australia.
- 7Intensive Care Unit, Northern Health, Australia.
Abstract
Purpose
Large-bore mechanical thrombectomy is an emerging treatment for intermediate-high-risk pulmonary embolism. We report outcomes from an Australian cohort.Material and methods
A retrospective analysis compared patients with intermediate-high-risk pulmonary embolism, defined according to the 2019 European Society of Cardiology guidelines, who were managed before large-bore mechanical thrombectomy implementation (May 2023-April 2024) with those treated with large-bore mechanical thrombectomy (May 2024-October 2025) at a teaching hospital within a multidisciplinary pulmonary embolism response team framework. The primary endpoint was procedural feasibility and safety. Secondary endpoints included hemodynamic changes, intensive care unit utilization and 30-day mortality.Results
Sixty-seven patients were included: 24 treated with large-bore mechanical thrombectomy (median age 66.5, interquartile range 51.8-73.0 years; 58.3% male) and 43 treated with anticoagulation and/or thrombolysis (median age 76.0, interquartile range 65.5-82.5 years; 34.9% male). Technical success was 100%. Mean pulmonary arterial pressure decreased from 28.5 ± 8.7 to 21.2 ± 5.6 mmHg (p < 0.001). Heart rate and respiratory rate improved at 24 hours (both p < 0.001), although adjusted analyses showed no significant between-group differences in hemodynamic changes. Intensive care unit length of stay was shorter in the large-bore mechanical thrombectomy group (20.1 ± 7.9 vs 32.2 ± 17.3 hours, p = 0.003), with multivariable analysis confirming an independent 43% reduction (exp(β) = 0.57, 95% confidence interval 0.42-0.79, p = 0.001). No major bleeding events or deaths within 30-days occurred in the large-bore mechanical thrombectomy group, compared with two major bleeding events (4.7%) and three mortalities (7.0%) in the non-large-bore mechanical thrombectomy group.Conclusions
Large-bore mechanical thrombectomy appears to be a safe and feasible treatment modality for intermediate-high-risk pulmonary embolism and was associated with reduced intensive care unit utilization compared with conventional therapies. These findings are hypothesis-generating and require validation in larger, prospective studies.
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BibTeX
@article{wong2026largebore,
title = {{Large-bore Mechanical Thrombectomy for Treatment of Intermediate-high Risk Pulmonary Embolism: A Single-center Australian Experience.}},
author = {Roy Kingsley Wong and Goran Mitreski and Hui Yin Lim and David Crosbie and Rohit Paliwal and Philip Chan and Tamburayi Cephas Kamba and Jack Griffin and Prahlad Ho and Hong Kuan Kok},
journal = {Interventional radiology (Higashimatsuyama-shi (Japan)},
year = {2026},
month = oct,
doi = {10.22575/interventionalradiology.2026-0006},
url = {https://europepmc.org/article/MED/42952484},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Large-bore Mechanical Thrombectomy for Treatment of Intermediate-high Risk Pulmonary Embolism: A Single-center Australian Experience.
AU - Roy Kingsley Wong
AU - Goran Mitreski
AU - Hui Yin Lim
AU - David Crosbie
AU - Rohit Paliwal
AU - Philip Chan
AU - Tamburayi Cephas Kamba
AU - Jack Griffin
AU - Prahlad Ho
AU - Hong Kuan Kok
PY - 2026
DA - 2026/10/15
JO - Interventional radiology (Higashimatsuyama-shi (Japan)
DO - 10.22575/interventionalradiology.2026-0006
UR - https://europepmc.org/article/MED/42952484
AB - Purpose Large-bore mechanical thrombectomy is an emerging treatment for intermediate-high-risk pulmonary embolism. We report outcomes from an Australian cohort.Material and methods A retrospective analysis compared patients with intermediate-high-risk pulmonary embolism, defined according to the 2019 European Society of Cardiology guidelines, who were managed before large-bore mechanical thrombectomy implementation (May 2023-April 2024) with those treated with large-bore mechanical thrombectomy (May 2024-October 2025) at a teaching hospital within a multidisciplinary pulmonary embolism response team framework. The primary endpoint was procedural feasibility and safety. Secondary endpoints included hemodynamic changes, intensive care unit utilization and 30-day mortality.Results Sixty-seven patients were included: 24 treated with large-bore mechanical thrombectomy (median age 66.5, interquartile range 51.8-73.0 years; 58.3% male) and 43 treated with anticoagulation and/or thrombolysis (median age 76.0, interquartile range 65.5-82.5 years; 34.9% male). Technical success was 100%. Mean pulmonary arterial pressure decreased from 28.5 ± 8.7 to 21.2 ± 5.6 mmHg (p < 0.001). Heart rate and respiratory rate improved at 24 hours (both p < 0.001), although adjusted analyses showed no significant between-group differences in hemodynamic changes. Intensive care unit length of stay was shorter in the large-bore mechanical thrombectomy group (20.1 ± 7.9 vs 32.2 ± 17.3 hours, p = 0.003), with multivariable analysis confirming an independent 43% reduction (exp(β) = 0.57, 95% confidence interval 0.42-0.79, p = 0.001). No major bleeding events or deaths within 30-days occurred in the large-bore mechanical thrombectomy group, compared with two major bleeding events (4.7%) and three mortalities (7.0%) in the non-large-bore mechanical thrombectomy group.Conclusions Large-bore mechanical thrombectomy appears to be a safe and feasible treatment modality for intermediate-high-risk pulmonary embolism and was associated with reduced intensive care unit utilization compared with conventional therapies. These findings are hypothesis-generating and require validation in larger, prospective studies.
SN - 2432-0935
ER -