Outcomes of catheter-directed mechanical thrombectomy in patients with cancer-associated pulmonary embolism: a multicenter, prospective registry.

BACKGROUND: Cancer-associated pulmonary embolism (PE) is a commonplace complication that contributes to morbidity and mortality. Data of catheter-directed mechanical thrombectomy (CDMT) in patients with cancer are limited. OBJECTIVES: To assess the efficacy and safety of CDMT in patients with intermediate-high or high-risk PE and cancer comorbidity. METHODS: Multicenter prospective, observational study of 290 PE patients treated with CDMT using continuous vacuum aspiration thrombectomy systems. Patients were classified into 2 groups: oncologic patients (OP) and nononcologic patients (NOP). The primary safety endpoints included in-hospital all-cause mortality and procedure-related major bleeding. The primary efficacy endpoint was the change in right-to-left-ventricle (RV/LV) ratio before and 48 hours after CDMT. The efficacy and safety of CDMT were compared between OP and NOP. RESULTS: Active cancer was observed in 18.3% (53/290) of patients with PE treated with CDMT. OP did not differ significantly from NOP in terms of baseline characteristics. After treatment, both OP and NOP demonstrated RV/LV ratio reduction by 27% (the mean change of -0.37 ± 0.22 (P < .001) in OP vs -0.31± 0.21 (P < .001) in NOP, P = .166). Major bleeding occurred in 1.9% (1/53) of OP and in 0.8% (2/237) of NOP (P = .455). The rate of all-cause in-hospital mortality reached 9.4% (5/53) in OP and 6.4% within NOP (P = .383). CONCLUSIONS: CDMT in OP characterized an acceptable safety profile and substantial improvement in RV function, similar to those observed in NOP. Patients with cancer-related PE had similar in-hospital survival rate compared with patients without cancer, when treated with CDMT.