Pulmonary Embolism

Pulmonary Embolism Resource Hub

Venous thromboembolism is a serious disease. Both deep vein thrombosis and pulmonary embolism frequently result in devastating impacts for patients in both the short and the long term. Pulmonary Embolism affects about 1000 out of every 1 million people with 200 of those cases considered to have an intermediate-high and high risk of mortality. Pulmonary Embolism, while preventable, is the 3rd leading cause of cardiovascular death.

As high mortality rates have shown little improvement over the last 20 years, it is clear acute PE patients need to be managed differently. We know that conservative treatment options, as recommended by the guidelines, leave thrombus behind in 20-50% of patients. Literature shows the mortality number on anticoagulation only is still high and the majority of venous clot is lytic-resistant by the time of treatment. Thrombolysis comes with significant risk of bleeds.

This section presents key papers, IHR and HR PE case reports, and also interviews with Key Opinion Leaders discussing how new technologies, like a lytic-free thrombectomy, can transform the treatment of acute Pulmonary Embolism.

Endorsed by Prof Felix Mahfoud
Pulmonary embolism remains a leading cause of cardiovascular death, with high mortality and morbidity rates showing little improvement over the last 20 years. This section explores how innovative treatment options, such as mechanical thrombectomy, along with new approaches to risk stratification and patient selection, can improve acute PE management and patient outcomes.

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Highlights

Acute PE Risk Stratification

Gain valuable insights from Prof Sripal Bangalore of New York University School of Medicine (US) on the necessity of updating current risk stratification for acute pulmonary embolism (PE).

In this concise video, Prof Bangalore emphasises the significance of the Composite Shock Score, which incorporates predictors of normotensive shock. The aim of this approach is to reduce the mortality rate of Intermediate PE patients, which can still reach up to 15%.

Prof Bangalore explains why anticoagulation therapy does not suffice in certain cases and advocates for intervention in stable normotensive acute PE patients.

New Approach to Risk Stratification in Acute PE

Join Prof Catalin Toma from the University of Pittsburgh School of Medicine (US) as he explores the latest approach to risk stratification in acute pulmonary embolism (PE). Gain insights into defining stages of cardiogenic shock specific to PE and understand the rationale behind early interventions.

Prof Toma shares his expertise in managing Intermediate-High and High-Risk PE, emphasising the pivotal role of an interventional treatment in patient care.

“It’s not what tPA can do for you but what aspiration thrombectomy can do for your patient”.

Multidisciplinary Approach in PE Management

Ensuring that all acute PE patients admitted to the hospital are properly assessed and receive the most effective treatment is crucial.

Dr Ana Viana-Tejedor and Dr Pablo Salinas from Hospital Clínico San Carlos in Madrid share their insights and experiences on how to achieve this.

Acute PE Risk Stratification

Why Update Risk Stratification for Acute PE?

The aim of this approach is to reduce the mortality rate of Intermediate PE patients, which can still reach up to 15%. Prof Sripal Bangalore, New York University School of Medicine (US), explains why anticoagulation therapy does not suffice in certain cases and advocates for intervention in stable normotensive acute PE patients.

New Approach to Risk Stratification in Acute PE

Prof Catalin Toma, University of Pittsburgh School of Medicine (US), shares his expertise in managing Intermediate-High and High-Risk PE, emphasising the pivotal role of an interventional treatment in patient care. “It’s not what tPA can do for you but what aspiration thrombectomy can do for your patient”.

Transforming the Treatment of Acute PE

Why Proven Predictors of PE Mortality Are Key to Effective Management

Up to 40% of “intermediate-risk” PE patients have a low cardiac index, which is suggestive for subclinical shock. It is impossible to predict which patients may decompensate. Even though proven predictors for PE mortality exist, they are not being considered by current guidelines. What can help to transform an approach for acute PE treatment?

Risk Stratification Examples from PE Centres

Does the current standard of care for PE patients keep up with the latest clinical evidence? Hear from Dr Stefano Barco (University Hospital Zurich, CH), Prof Catalin Toma (University of Pittsburgh School of Medicine, US) and Prof Bernhard Gebauer (Charité – Berlin University Medicine, GE) to learn more about the gaps and limitations in current treatment guidelines and how the latest clinical updates can help to define the patient group eligible for the interventional treatment of acute PE.

When to Intervene?

Building a PE Patient Pathway

What does mechanical thrombectomy bring to the PE patient pathway? Hear from Dr Ole Gretta (Oslo University Hospital, NO), Dr Ana Viana-Tejedor (Hospital Clínico San Carlos, SP) and Dr Maximilian de Bucourt (Charité Campus Benjamin Franklin, GE) to learn from practical European examples, how a PE referral network and a standardised PE pathway can impact the treatment and outcomes of acute PE patients.

Multidisciplinary Approach in PE Management

Ensuring that all acute PE patients admitted to the hospital are properly assessed and receive the most effective treatment is crucial. Dr Ana Viana-Tejedor and Dr Pablo Salinas from Hospital Clínico San Carlos in Madrid share their insights and experiences on how to achieve this.

PE Guidelines in Action: Determining Eligibility for Interventional Treatment

How can we ensure that every PE patient admitted to hospital follows a consistent pathway and receives treatment based on standardised criteria? Join Dr Ana Viana-Tejedor and Dr Pablo Salinas from Hospital Clínico San Carlos in Madrid as they discuss the key parameters they consider when selecting the right treatment for their PE patients.

ESC Guidelines PE Treatment Decision Tree

This document provides a detailed overview of the treatment decision tree for pulmonary embolism (PE) based on the latest guidelines and consensus statements.
This downloadable PDF serves as a practical tool for HCPs to navigate the complexities of PE treatment, ensuring evidence-based care that aligns with the latest standards.

PE Treatment Pathway

PE Treatment Pathway at Hospital Clínico San Carlos, Madrid

This downloadable PDF outlines the treatment pathway for patients diagnosed with acute pulmonary embolism (PE) developed at Hospital Clínico San Carlos in Madrid. The pathway is designed to guide clinicians from this centre through the critical steps of managing high-risk and intermediate-high-risk PE cases.

Clinical Updates

What are the European Updates on the FLASH Registry?

Join Prof Felix Mahfoud, University Hospital Basel (CH), as he shares his approach to risk stratification for Intermediate-High PE patients. Discover the significance of prevention from normotensive shock and learn how to better assess and identify patients on the edge of deterioration, potentially benefiting from interventional treatment.

How to Manage the Sickest PE Patient - Results From the FLAME Study

In this video, learn from Dr Tom Tu (Inari Medical, US), Prof Felix Mahfoud (University Hospital Basel, CH) and Dr Jay S Giri (Hospital of the University of Pennsylvania, US) about using practical case examples, how mechanical thrombectomy can improve the mortality risk of High-risk PE patients and why the FLAME study disrupts the current level of clinical evidence in High-risk PE patients.

How Can We Improve the Mortality of High-risk PE Patients

Dr Mitchell Silver shares his experiences in the treatment of high-risk PE patients and explains why mortality of those patients haven’t significantly improved over the last 20 years. Watch this interview to learn more about the FLAME’s outcomes – the largest prospective study of interventional treatment in High-risk PE.

Mechanical Thrombectomy in Action

Achieving Immediate Impact in Acute PE Treatment

European experience in achieving an immediate impact using a lytic-free approach to acute PE treatment. Learn from experience European centers how mechanical thrombectomy can improve the outcomes of intermediate-high and high risk PE patients, using a lytic-free approach with immediate hemodynamic impact.

Acute PE Treated at Hôpital Européen Georges-Pompidou Paris, FR

Young woman developed a High-Risk PE post hip surgery and was placed on ECMO. Mechanical thrombectomy using 24 French in combination with a 16 French Triever catheter cleared the Pulmonary arteries and stabilised the patient on the table.

Acute PE Treated at Universitätsspital Basel, CH

Patient with known history of PE and DVT experienced a syncope and was diagnosed with a massive PA thrombus load, elevated right heart strain and troponin. Combination of aspiration and mechanical thrombectomy with FlowTriever disks removed both acute and sub-acute thrombus and resulted in an immediate haemodynamic improvement on the table.

Acute PE Treated at Hospital Santa Cruz Lisbon, PT

Young female with an intermediate-high risk, normotensive, saddle PE did not respond to conservative treatment on anticoagulation. 8 aspirations with the FlowTriever system removed the large saddle embolus and resulted in an immediate reduction of the Pulmonary Artery Pressure on the table.

Acute PE Treated at AZ Sint Jan Brugge, BE

In this video, a patient admitted at the ER department with dyspnea and diagnosed with an intermediate-high risk Pulmonary embolism with elevated RV strain and troponin level. Great thrombus clearance using different tools of the FlowTriever system, resulting in an immediate haemodynamic impact.

Patient Stories

Life Without Clot

Andrea’s Patient Story

Andrea's acute pulmonary embolism treated by Dr Moazz Elsharabassy (GE).

Life Without Clot

Vanessa’s Patient Story

Vanessa's pulmonary embolism treated by Dr Mohammed Rashid Akhtar (UK).

Life Without Clot

Gema's Patient Story

Gema's pulmonary embolism at 28 weeks, treated by Dr Alfonso Jurado Roman (Madrid, ES).

Clinical Publications

Prevalence and predictors of cardiogenic shock in intermediate-risk pulmonary embolism: Insights from the FLASH registry

Bangalore S, Horowitz JM, Beam D, et al. JACC Cardiovasc Interv 2023;16:958–72.

Acute outcomes for the full US cohort of the FLASH mechanical thrombectomy registry in pulmonary embolism

Toma C, Jaber WA, Weinberg MD, et al. EuroIntervention 2023;18:1201–12.

Percutaneous mechanical thrombectomy in a real-world pulmonary embolism population: Interim results of the FLASH registry

Toma C, Bunte MC, Cho KH, et al. Catheter Cardiovasc Inter 2022;99:1345–55.

Outcomes in high-risk pulmonary embolism patients undergoing FlowTriever mechanical thrombectomy or other contemporary therapies: results from the FLAME study

Outcomes in high-risk pulmonary embolism patients undergoing FlowTriever mechanical thrombectomy or other contemp

Silver MJ, Gibson CM, Giri J et al. Circ Cardiovasc Interv 2023;16:e013406.

Percutaneous thrombectomy in patients with massive and very high-risk submassive acute pulmonary embolism

Toma C, Khandhar S, Zalewski AM et al. Catheter Cardiovasc Interv 2020;96:1465–70.

Validating the composite pulmonary embolism shock score for predicting normotensive shock in intermediate-risk pulmonary embolism

Zhang RS, Alman U, Sharp ASP et al. Circ Cardiovasc Interv 2024;17:e013399.

Morbidity following pulmonary embolism hospitalisation-contributing factors and outcomes

Welker C, Huang J, Elmadhoun O et al. J Cardiothorac Vasc Anesth 2024;38:1239–43.

A multidisciplinary pulmonary embolism response team (PERT): First experience from a single centre in Germany

Sagoschen I, Scibior B, Farmakis IT et al. Clin Res Cardiol 2024;113:581–90.

Ultrasound‐assisted endovascular thrombolysis versus large‐bore thrombectomy in acute intermediate‐high risk pulmonary embolism: The propensity‐matched EKNARI cohort study

Hani Al-Terki, Lauder L, Mügge A et al. Catheter Cardiovasc Interv 2024;103:758–65.

Percutaneous mechanical thrombectomy in acute pulmonary embolism: Outcomes from a safety-net hospital

Zhang RS, Alviar CL, Yuriditsky E et al. Catheter Cardiovasc Interv 2024;103:1042–49.

Composite pulmonary embolism shock score and risk of adverse outcomes in patients with pulmonary embolism

Zhang RS, Yuriditsky E, Zhang P et al. Circ Cardiovasc Interv 2024;e014088.