Systemic Thrombolysis vs Catheter-Directed Intervention for Pulmonary Embolism: A Multi-Center Study

Monday, March 23, 2026

11:30 AM - 12:30 PM Central Time

Location: Connections Central - RST 02

JA

Jesse Abelson, MD (he/him/his)

Abbott Northwestern, Minnesota

Disclosure(s): No relevant financial relationship(s) to disclose.
Collin Barrett, MD

Abbott Northwestern Hospital, Minnesota

Disclosure(s): No relevant financial relationship(s) to disclose.
DT

David Tierney, MD, FACP

Program Director
Abbott Northwestern Hospital

Disclosure information not submitted.
AB

Amanjit Baadh, MD

Interventional Radiologist
Midwest Radiology

Disclosure information not submitted.
SM

Summer Martins, PhD, MPH

Senior Research Scientist
Allina Health Research

Disclosure information not submitted.
SC

Sandra Castro-Pearson, PhD

Statistician
Allina Health Research

Disclosure information not submitted.
AA

Amy Almquist, MPH

Research Project Specialist
Allina Health Research

Disclosure information not submitted.
NS

Nedaa Skeik, MD, FACC

Vascular Medicine Physician
Minneapolis Heart Institute, Abbott Northwestern Hospital

Disclosure information not submitted.
Caitlin S. Brown, BCCCP, PharmD, FCCM (she/her/hers)

Mayo Clinic, Minnesota

Disclosure information not submitted.
RX

Ranran Xia, PharmD

Pharmacist
Mayo Clinic

Disclosure information not submitted.
MK

Mehdi Kashani, n/a

research fellow
mayo clinic

Disclosure information not submitted.
mn

marko nemet, MD

Pulmonology and Critical Care Research Trainee
Mayo Clinic

Disclosure information not submitted.
CG

Cameron Gmehlin, MD

Internal Medicine Resident
Mayo Clinic

Disclosure information not submitted.
oG

ognjen Gajic, MD, FCCM

MD
Mayo Clinic Rochester

Disclosure information not submitted.
RM

Roman Melamed, MD, FCCP

Intensivist
Abbott Northwestern Hospital

Disclosure information not submitted.

Introduction: Systemic thrombolysis (ST) and catheter-directed interventions (CDI) are used in patients with pulmonary embolism (PE) requiring reperfusion therapy. Both improve outcomes in select patients but also carry a risk of complications. Limited outcome and complication data exist for ST vs. CDI. We hypothesized that these two modalities result in similar clinical outcomes and complications.

Methods: This inverse probability of treatment weighted (IPTW), multi-center, retrospective study compared outcomes and complications of patients hospitalized (2013 - 2023) with PE at three metropolitan referral centers of a single healthcare system who were treated with ST or CDI.

Results: 316 patients were treated with ST and 285 with CDI. After IPTW, the median age in both groups was 64 years. The proportions of submassive and massive PE were 81% and 18%. Hospital (5.2% vs. 3.0%, p = 0.19) and 1-yr (10.4% vs. 9.3%, p = 0.70) mortality, length of stay (3.27 vs. 3.32 days, p = 0.48), 30-day readmissions (9.4% vs. 7.4%, p = 0.45), and incidence of minor (6.0% vs 9.9%, p = 0.090), major extracranial (4.8% vs 2.0%, p = 0.072), or intracranial (0.8% vs 0.7%, p = 0.972) hemorrhage did not differ between CDI and ST, respectively. Post-intervention hypotension (6.9% vs. 2.3%, p = 0.01) and cardiac arrest (4.3% vs. 0.8%, p = 0.001) occurred more frequently in the CDI group. The need for escalation of care was similar between the two groups, with 3.7% of ST patients requiring subsequent CDI, and 4.0% of CDI patients requiring subsequent ST. There was no significant difference in patients requiring escalation to ECMO (1.2% vs. 0.4%, p = 0.30).

Conclusions: In this multi-center study, ST and CDI resulted in similar mortality, overall complications, and escalation of care among patients requiring reperfusion therapy for PE. Future prospective studies are needed to confirm these results, further evaluate outcomes such as cardiac arrest, and to compare the cost-effectiveness of these two interventions.