Dr Krunal Patel: New Research Explains the Impact of Early Mechanical Thrombectomy in Acute PE

At the CHEST 2024 conference, a session on navigating pulmonary embolism (PE) highlighted research results regarding the timing of mechanical thrombectomy for acute pulmonary embolism. The team of investigators, which included Krunal Patel, MD, a pulmonary critical care fellow at Temple University Hospital, and Parth Rali, MD, FCCP, director of fellowship wellness and social media, Pulmonary and Critical Care Fellowship, and associate professor of thoracic medicine and surgery, Lewis Katz School of Medicine at Temple University, reviewed data from the FLASH registry, focusing on the efficacy and safety of thrombectomy devices.

Patel explained that their research aimed to explore whether performing a thrombectomy within 12 hours of symptom onset yielded better outcomes than later interventions. The findings suggested that earlier intervention could significantly improve patient hemodynamics, hinting at the potential for new guidelines in the treatment of PE.

This transcript has been lightly edited for clarity.

Transcript

What were the highlights from your CHEST session focusing on navigating pulmonary embolism (PE)?

It was an interesting presentation. We were really talking about the FLASH registry database; there had already been recently published data called the FLASH registry. So, just doing a high-level review—it really looked at the efficacy of their mechanical thrombectomy catheter devices. It showed that it's a relatively safe product, had adverse effects of less than 2%, and had high-level mortality benefits. What we really wanted to check, Dr. [Parth] Rali—who's also one of my mentors and colleagues at Temple University—and I wanted to see whether early vs late mechanical thrombectomy had any sort of signal.

We know mechanical thrombectomy works. I think now the next question is not whether it works or not or if it's safe—those answers have relatively been answered—it's more so timing. We know for cardiac, for MIs [myrocardial infarctions], the door-to-balloon time is about 90 minutes. So our kind of thought-provoking study was to determine if we can maybe figure out a signal to determine whether early, less than 12 hours, intervention vs slightly delayed, greater than 12 hours had any sort of positive signal.

Were there any interesting findings from your research examining the influence of expedited mechanical thrombectomy on outcomes in acute pulmonary embolism?

Yeah, so you imagine the short [interval] group was slightly sicker. The average time in the short interval [intervention], which was 12 hours or less, was about 6 hours to intervention. Then, the longer group was about 24 hours to intervention. Even though we had stratified the 2 groups into short—from less than 12 hours and greater than 12 hours—the average was about 6 hours vs about 24 hours. And you can imagine that the shorter group was slightly sicker.

But even when we kind of accounted for their level of acuity and level of sickness, still they had greater benefit in their hemodynamics; so their mean pulmonary artery pressures, their systolic pulmonary artery pressures, their 6-minute walk tests were all a lot better, even when we kind of calculated for these confounders. So, that was very interesting. It begs the question of whether we should be intervening on these patients at an earlier timeframe rather than slightly delayed.

Reference

Patel KH, Rali P. Influence of expedited mechanical thrombectomy on outcomes in acute pulmonary embolism: FLASH registry insights. CHEST. 2024;166(4):A5837-A5838.