Catheter-directed aspiration thrombectomy with the indigo system for intermediate- and high-risk pulmonary embolism in older patients: preliminary findings from a single-center experience.

PURPOSE: Percutaneous mechanical thrombectomy (PMT) is a promising treatment for pulmonary embolism (PE), especially in older patients at high bleeding risk. This study assessed its safety and efficacy in patients with acute PE aged over 75 years. METHODS: Using data from the prospective, multicenter China Pulmonary Thromboembolism Registry Study (NCT02943343), this study included all consecutive patients aged > 75 years with confirmed PE who underwent catheter-directed aspiration thrombectomy using the Indigo Aspiration System at the Affiliated Hospital of Jianghan University between April 2020 and November 2024. The efficacy of PMT included improvements in hemodynamics, vital signs, dyspnea, and cardiac function. The safety endpoints were the incidence of major adverse events and major bleeding. RESULTS: Of the 673 patients screened, 202 received PMT, and the data of 60 patients were analyzed. After the procedure, heart rate significantly decreased by an average of 4.40 bpm (5.1%, P = 0.007) and mean pulmonary arterial pressure significantly improved by 3.40 mmHg (13.3%, P < 0.001). At 48 hours post-procedure, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels significantly decreased from 2,102.3 (556.5, 3,772.0) to 898.6 (561.1, 1,670.6) pg/mL (P < 0.001) and Modified Medical Research Council dyspnea scores improved from 2.52 ± 1.24 pre-procedure to 1.22 ± 1.03 (P < 0.001). Subgroup analysis revealed that patients with a low clot burden also had significant improvements in heart rate, NT-proBNP, and dyspnea score after surgery. No major bleeding occurred within 3 months. CONCLUSION: PMT is safe and effective for older patients with acute PE. Potential advantages include immediate hemodynamic improvements, significant symptom alleviation, and recovery of right ventricular function, accompanied by minimal adverse events. CLINICAL SIGNIFICANCE: Percutaneous mechanical thrombectomy is safe and effective in elderly patients with acute pulmonary embolism, including those at high bleeding risk, providing rapid hemodynamic and functional improvement with low major adverse events. Even patients with low clot burden derive clinical benefit.