Mechanical Thrombectomy Versus Systemic Thrombolysis in Hemodynamically Unstable High-Risk Pulmonary Embolism Requiring Vasopressors: A Propensity-Matched Outcomes Analysis From TriNetX Network
In brief
Mechanical thrombectomy cuts death risk by about half in unstable high-risk pulmonary embolism
In a propensity-matched analysis of 1,052 patients per arm, mortality was roughly 18% lower with thrombectomy (79% survival versus 61% with systemic thrombolysis). Hemorrhagic and ischemic strokes were also less frequent. The data are retrospective, so randomized trials are needed before changing practice.
- Journal
- Journal of the Society for Cardiovascular Angiography & Interventions (Q2)
- Published
- 4 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ashok Runkana, Ravi Medarametla, Raam Mannam, Surabhi Maheshwari, James B Hermiller
- PMID
- 42769895
- DOI
- 10.1016/j.jscai.2026.105515
Why clinicians should know about it
- Picked for Emergency Medicine (top studies of the week, 27 September 2026): Mortality lower with thrombectomy vs thrombolysis
Abstract
BACKGROUND: High-risk pulmonary embolism (PE) is associated with high mortality. Optimal reperfusion strategy remains debated. Systemic thrombolysis (ST) is traditionally used but carries a high risk of intracranial bleeding. Catheter-directed or mechanical thrombectomy (MT) may be safer, but real-world data are limited. We compared thrombectomy vs thrombolysis using a multicenter data network. METHODS: We conducted a retrospective cohort study on the TriNetX Research Network across 107 healthcare organizations. Adults with hemodynamically unstable PE on vasopressors from January 2016 to September 2025 who received MT (n = 1064) or ST (n = 3325) within 1 day of diagnosis were included. We excluded patients with COVID-19, malignancy, obstetric conditions, trauma, and burns. Propensity matching (1:1) for Pulmonary Embolism Severity Index (PESI) variables and other baseline characteristics yielded 1052 per group. RESULTS: Mortality was lower with MT (RR, 0.53; 95% CI, 0.44-0.63). Kaplan-Meier analysis showed better survival in the matched MT group (79.4% vs 61.3%; P < .001). Hemorrhagic stroke (RR, 0.71; 95% CI, 0.41-1.22) and ischemic stroke (RR, 0.80; 95% CI, 0.57-1.13) were also reduced in the thrombectomy group. CONCLUSIONS: Thrombectomy was associated with lower mortality and fewer strokes vs thrombolysis. Thrombectomy appears safer and more effective for high-risk PE. This finding is hypothesis generating. Large randomized controlled trials, although difficult to conduct, are needed to validate these findings.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.