Endovascular Treatment of Pulmonary Embolism

Acute pulmonary embolism is the third leading cause of cardiovascular mortality and the most preventable cause of hospital mortality. Anticoagulation was and remains the standard of care for treatment of pulmonary embolism (PE) and prevention of thrombus extension or recurrence. Anticoagulation, however, does not dissolve thrombus, but rather prevents formation of more clots while intrinsic thrombolytic pathways are slowly taking over. In higher-risk cases, when ventricular function is acutely compromised, faster clot removal is needed to prevent cardiac decompensation. Administration of systemic thrombolytics can be highly effective in rapidly resolving pulmonary thrombus. However, as it can result in significant bleeding complications, or frequently contraindicated (e.g. recent surgery or trauma), interventional treatments to rapidly remove the clot from the pulmonary arteries have always been attractive. Catheter-directed interventions for acute PE, with or without thrombolytics, have been increasingly used over the past decade and evidence on their effectiveness is mounting.