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Purpose <p>This study aimed to evaluate the safety and efficacy of catheter-directed mechanical thrombectomy without adjunctive thrombolysis in patients with intermediate-to-high-risk acute pulmonary embolism.</p> Materials and Methods <p>A systematic review was performed across PubMed, Embase and the Cochrane Library until January 21, 2026. We included studies with intermediate-to-high-risk pulmonary embolism patients that underwent mechanical thrombectomy without thrombolysis. Continuous outcomes were analyzed using means and binary outcomes using proportion of events ratios, each with corresponding 95% confidence intervals. All analyses were performed using R software (version 4.4.1).</p> Results <p>A total of 13 studies comprising 1001 patients were included. The pooled rate of major bleeding was 2.39% (95% CI 1.20–3.58). In-hospital mortality occurred in 0.38% of patients (95% CI 0.00 to 1.00), and 30-day all-cause mortality was 0.72% (95% CI 0.00–1.49). Mean reduction in right ventricle-to-left ventricle ratio was 0.42 (95% CI 0.38–0.46). The mean intensive care unit and hospital length of stay were 1.96&#xa0;days (95% CI 1.22–2.70) and 5.41&#xa0;days (95% CI 4.48–6.34), respectively. Subgroup analyses suggested that higher bleeding and mortality rates were associated with higher-risk populations and smaller catheter sizes, although differences were not statistically significant.</p> Conclusion <p>This meta-analysis suggests that catheter-directed mechanical thrombectomy without thrombolysis for intermediate-to-high-risk pulmonary embolism is associated with low rates of bleeding and mortality, improvements in hemodynamic parameters and short hospital and intensive care unit stays.</p> Graphical Abstract

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Catheter-Directed Mechanical Thrombectomy without Thrombolysis for Intermediate-to-High-Risk Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年4月1日

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  • Gustavo Regus Schuster,
  • Rafaela Correia Maciel,
  • Maria Clara Merighi,
  • Cláudia Figueredo Nascimento Salomão Santos,
  • Gabriela Gracioli de Lima,
  • Genocir Franke,
  • Elisa Carvalho Ferreira,
  • Iago Vinicius Maia Hezel,
  • Bernard Campos Araruna Giancristoforo

摘要

Purpose

This study aimed to evaluate the safety and efficacy of catheter-directed mechanical thrombectomy without adjunctive thrombolysis in patients with intermediate-to-high-risk acute pulmonary embolism.

Materials and Methods

A systematic review was performed across PubMed, Embase and the Cochrane Library until January 21, 2026. We included studies with intermediate-to-high-risk pulmonary embolism patients that underwent mechanical thrombectomy without thrombolysis. Continuous outcomes were analyzed using means and binary outcomes using proportion of events ratios, each with corresponding 95% confidence intervals. All analyses were performed using R software (version 4.4.1).

Results

A total of 13 studies comprising 1001 patients were included. The pooled rate of major bleeding was 2.39% (95% CI 1.20–3.58). In-hospital mortality occurred in 0.38% of patients (95% CI 0.00 to 1.00), and 30-day all-cause mortality was 0.72% (95% CI 0.00–1.49). Mean reduction in right ventricle-to-left ventricle ratio was 0.42 (95% CI 0.38–0.46). The mean intensive care unit and hospital length of stay were 1.96 days (95% CI 1.22–2.70) and 5.41 days (95% CI 4.48–6.34), respectively. Subgroup analyses suggested that higher bleeding and mortality rates were associated with higher-risk populations and smaller catheter sizes, although differences were not statistically significant.

Conclusion

This meta-analysis suggests that catheter-directed mechanical thrombectomy without thrombolysis for intermediate-to-high-risk pulmonary embolism is associated with low rates of bleeding and mortality, improvements in hemodynamic parameters and short hospital and intensive care unit stays.

Graphical Abstract