General Cardiology Fellow, PGY-5 Allegheny General Hospital Allegheny Health Network Pittsburgh, Pennsylvania, United States
Disclosure(s):
Charles F. Ebersbacher, DO, MBA: No financial relationships to disclose
Background: Large bore mechanical thrombectomy (LBMT) is an evolving treatment for pulmonary embolism (PE), especially in cardiogenic shock. Clinical trials studying the use of LBMT in PE have not included patients over 75 years of age, representing a critical knowledge gap.
Methods: We retrospectively identified consecutive patients from January 1, 2024, to January 1, 2025, who were ≥ 80 years of age who presented with PE and were managed with LBMT.
Outcome: We identified twelve octogenarians with PE who underwent LBMT. Median age was 82 [IQR 81-85] years. Seven patients had syncope at presentation and 2 had cardiac arrest. The Pulmonary Embolism Severity Score (PESI) was very high risk (>145) in the majority (75%, N=9/12) of patients. Lactate was > 2.0 mmol/L for most patients (67%, N=8/12). Initial cardiac index (CI) by Fick method was ≤ 2.2 L/min/m2 in most (58%, N=7/12) patients. Mechanical circulatory support was used in 2 patients, one of them died. Four patients had a clinically significant bleeding event (Bleeding Academic Research Consortium scale (BARC>3), there were 2 acute kidney injuries requiring dialysis and only 1 had severe vascular injury requiring intervention. Intensive care unit and hospital length of stay 2.5 [IQR 1-5.75] and 6 [IQR 3.25-9.75] days respectively. Most patients survived to discharge (N=11/12, 92%).
Conclusion: We demonstrate excellent short-term outcomes with LBMT in a sick cohort of octogenarians who presented with intermediate-to-high-risk PE.
