Endovascular Treatment of Pulmonary Embolism

Acute pulmonary embolism can result in high rates of morbidity and mortality. Traditional treatments for pulmonary embolism such as systemic thrombolysis and surgical thrombectomy are associated with high complication rates. Advances in endovascular therapy have allowed for usage of minimally invasive approaches such as catheter-directed thrombolysis, aspiration thrombectomy, and pharmacomechanical thrombectomy in the treatment of acute pulmonary embolism. These therapies may provide similar hemodynamic improvement to traditional techniques while decreasing risks of serious complications. Acute pulmonary embolism is classified into low, intermediate, and high-risk presentations based on the presence or absence of hemodynamic instability, clinical risk factors, and biomarkers or imaging evidence of right ventricular dysfunction. Patients with high and intermediate-high risk presentations may benefit from intervention, but the risks of complications including intracranial hemorrhage must be taken into account when determining the type of intervention. Catheter-directed interventions have demonstrated good clinical success and excellent published safety profiles, but head-to-head comparisons of different interventional techniques have not been well studied. Further study of catheter-directed interventions and their effect on short- and long-term physiologic, functional, and quality-of-life outcomes is needed.