Innovation in Catheter-Directed Therapy for Intermediate-High-Risk and High-Risk Pulmonary Embolism

Although anticoagulation remains the cornerstone treatment for patients with acute pulmonary embolism (PE), catheter- directed therapy (CDT) has generated great interest as an adjunctive option for those presenting with hemodynamic decompensation or high risk for deterioration and in whom systemic thrombolysis has failed or is contraindicated. However, randomized controlled data supporting the efficacy and safety of CDT in addition to antithrombotic therapy in patients with high-risk and intermediate- to high-risk PE compared with anticoagulation and systemic thrombolysis alone are lacking. This paucity of high-quality data hampers guideline recommendations regarding the optimal therapeutic approach in such patients with PE. The aim of the present paper is to critically appraise the current evidence for CDT in patients with high-risk and intermediate- to high-risk PE and to highlight major areas of innovation in the recent literature. In addition, the authors describe unmet clinical and research needs, potential strategies to resolve these knowledge gaps, and pathways for device selection. (JACC Cardiovasc Interv. 2024;17:2259-2273) (c) 2024 by the American College of Cardiology Foundation.