Outcome Analysis of Catheter-Directed Thrombolysis and Mechanical Thrombectomy in Intermediate- and High-Risk Pulmonary Embolism: A Systematic Review and Meta-Analysis
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Abstract
Introduction: Pulmonary embolism (PE) is a severe condition associated with high morbidity and mortality, particularly in intermediate- and high-risk patients. Catheter-directed thrombolysis (CDT) and mechanical thrombectomy (MT) have emerged as advanced treatment modalities. This study aimed to systematically compare clinical outcomes between CDT and MT in this population. Materials and Methods: This systematic review and meta-analysis was registered in PROSPERO (CRD42023460836) and conducted according to PRISMA guidelines. A comprehensive literature search was performed in PubMed, Scopus, ProQuest, SAGE Journals, and Cochrane up to January 6, 2025. Study quality was assessed using the Newcastle-Ottawa Scale, and statistical analyses were performed using Review Manager 5.4.1. Results: Eight studies involving 5,438 patients were included. In-hospital mortality was similar between groups (CDT: 2.31%; MT: 2.96%; RR 0.82, 95% CI: 0.48–1.38; p = 0.45). MT was associated with a significantly reduced ICU length of stay (SMD 0.38, 95% CI: 0.15–0.62; p = 0.001). Rates of significant bleeding (RR 1.02, 95% CI: 0.70–1.47; p = 0.93) and major complications (RR 0.73, 95% CI: 0.36–1.45; p = 0.37) were comparable between groups. Post-procedural pulmonary artery pressure improved in both groups, with a slight advantage toward MT (SMD −0.17, 95% CI: −0.29 to −0.05; p = 0.006). Conclusion: CDT and MT demonstrate favorable outcomes in intermediate- and high-risk PE. MT may offer shorter ICU stays and improved pulmonary artery pressure, whereas other clinical outcomes appear comparable. Treatment should be individualized according to patient condition, bleeding risk, and institutional expertise.
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