Catheter-Directed Thrombolysis of Pulmonary Embolism

An estimated 10 million individuals worldwide experience venous thromboembolism (VTE) annually, leading to over 500,000 fatalities in Europe and a range of 100,000 to 300,000 deaths in the US. Pulmonary embolisms (PE) can manifest with varying degrees of severity, ranging from asymptomatic to sudden death. This broad spectrum highlights the importance of accurately assessing PE severity from the outset.

Given this diversity, it is critical to stratify patients based on their PE-related risk to tailor treatment approaches effectively. While anticoagulation therapy generally suffices for patients at low risk of complications, the benefits of active thrombus removal, such as catheter-directed thrombolysis (CDT), become increasingly evident with the severity of PE.

CDT has emerged as a nuanced treatment option, particularly for patients with intermediate to high-risk PE. This intervention aims to reduce the thrombus burden in the pulmonary arteries, potentially improving right ventricular (RV) function and patient outcomes. However, the application of CDT is not without risks, as the potential for bleeding and other complications must be weighed against the therapeutic benefits.

The landscape of interventional therapies for PE is evolving, with new devices and techniques being developed and approved for clinical use. This dynamic field necessitates a clear understanding of the current state of endovascular interventions and the development of evidence to guide their application in various clinical scenarios.