Aims: Catheter-directed treatments (CDTs) are emerging and attractive therapeutical options in pulmonary embolism (PE), due to the high prevalence of contraindications to systemic thrombolysis (ST). We aimed at evaluating safety and efficacy of CDTs in patients with high risk and intermediate-high risk PE showing contraindications to ST.

Methods and results: We included in our multicentre observational study 104 patients from 5 Interventional Centres: 42 (40.4%) patients with high risk and 62 (59.6%) with intermediate-high risk PE. Rheolytic thrombectomy (RT) was performed in 38 (36.5%), while ultrasound-assisted thrombolysis (USAT) was performed in the remaining 66 (63.4%). Loco-regional thrombolysis was used in 86.5% (rTPA median dose 20 mg, IQR 12-28). Procedural success was reached in 94.7% cases. No procedure-related deaths were reported. Major and minor bleeding occurred in 9.6% and 13.4%, respectively. One lethal intracranial bleeding occurred. Vascular complications occurred in 7% of cases. All-cause mortality was 16.3% in-hospital and 19.3% at one year. A significant improvement in echocardiographic parameters (right ventricle function and pulmonary pressure) was observed from hospital admission to one-year follow-up.

Conclusion: Our experience confirms safety and efficacy of CDTs in a high risk and intermediate high-risk PE patients presenting with contraindications to ST.