PURPOSE: Pulmonary embolism (PE) is a critical condition requiring prompt intervention. Mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT) are emerging catheter-based therapies, but their comparative effectiveness remains uncertain, particularly given the predominance of observational studies.
METHODS: We conducted a systematic review and meta-analysis of studies identified through PubMed, Embase, and Web of Science from inception to February 10, 2025. Both randomized controlled trials and observational studies were included. Random-effects models were used for all analyses to account for anticipated heterogeneity. Primary outcomes were all-cause mortality, all-cause readmission, and PE-related readmission. Secondary outcomes included hospital stay, procedural time, and safety events. Heterogeneity was assessed using the I2 statistic.
RESULTS: This meta-analysis included one randomized controlled trial (RCT) and six observational studies, comprising a total of 1369 patients (MT = 659, CDT = 710). MT was associated with a statistically significant reduction in hospital stay compared to CDT (Mean Difference = -0.47 days, 95 % CI: [-0.89, -0.05]; p = 0.03, I2 = 0 %). However, there were no significant differences between MT and CDT in terms of all-cause mortality (RR = 1.24, 95 % CI: [0.47, 3.30]; p = 0.66, I2 = 26 %), all-cause readmission (RR = 0.84, 95 % CI: [0.29, 2.41]; p = 0.75, I2 = 54 %), or PE-related readmission (RR = 0.64, 95 % CI: [0.13, 3.23]; p = 0.59, I2 = 0 %). Similarly, no significant differences were observed in procedural time (Mean Difference = 21.48 min, 95 % CI: [-5.20, 48.15]; p = 0.11, I2 = 95 %), fluoroscopy time (Mean Difference = 6.63 min, 95 % CI: [-3.14, 16.41]; p = 0.18, I2 = 93 %), or ICU stay (Mean Difference = -6.45 days, 95 % CI: [-20.25, 7.36]; p = 0.36, I2 = 100 %).
CONCLUSION: Current evidence, primarily from observational studies, suggests that MT and CDT offer comparable clinical outcomes in PE management, with MT potentially associated with a shorter hospital stay. However, given the limitations inherent to the available data, including study design and heterogeneity, these findings should be interpreted cautiously. Further high-quality randomized trials are needed to draw definitive conclusions.
| Specialty Area | Score |
|---|---|
| Emergency Medicine | |
| Hemostasis and Thrombosis | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine |
This meta-analysis included 1 RCT and 6 observational studies. I can't see the point in undertaking a meta-analysis of observational studies. The PEERLESS RCT gives the most reliable estimate of the effectiveness of MT compared with CDT. Combining the results of PEERLESS with observational studies just produces a more precise but biased estimate.
The only statistically significant difference was an average HALF-day reduction in ICU stay. Although this may be statistically significant, it is really not clinically relevant in the average hospital. Otherwise the results are expected.
This meta-analysis compared mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT) for pulmonary embolism. The search for articles was exhaustive, yielding one RCT and 6 observational studies. There were some concerns about risk of bias in the included studies. There were no differences between the two arms overall in outcomes of mortality, readmission, PE readmission, procedure time, fluoroscopy time or ICU length of stay, major bleeding, stroke, blood transfusion or cardiac arrest. MT was associated with a statistically significant reduction in hospital stay compared with CDT (Mean Difference = -0.47 days. However, looking at just the RCT, MT had shorter hospital and ICU length of stay (by about 1 day for each), longer fluoroscopy (by 12 min) and procedure time (by 28 min), and lower readmission rate. The authors suggest the results are only preliminary and more RCTs are needed.
Interesting review on the best interventional therapy for PE evaluated as a candidate for invasive treatment, but the criteria for invasive treatment versus medical treatment for intermediate severity PE remains uncertain. This aspect of treatment was not incorporated in the study.
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