A meta-analysis of efficacy and safety of catheter-directed interventions in submassive pulmonary embolism.

Objective: Catheter-directed interventions, such as catheter-directed thrombolysis (CDT), are becoming a popular therapeutic option for patients with hemodynamically stable pulmonary embolism (PE) and right ventricle (RV) dysfunction (submassive PE). We wished to quantitatively assess therapeutic efficacy and safety of catheter-directed interventions in submassive PE. Materials and

Methods: PubMed, Embase, Cochrane and Scopus were searched for studies on catheter-directed interventions and submassive PE. Studies reporting data on therapeutic efficacy (RV to left ventricle [RV/LV] ratio, systolic pulmonary artery pressure) and safety outcomes (in-hospital and 30-day mortality rates, major and minor bleeding rates) were retained and assessed.

Results: The final reference sample included 13 publications (11 papers and 2 conference abstracts), collectively enrolling 422 patients with submassive PE. The majority (8/13) studies were retrospective studies. One study was a randomized controlled study. Nine of 13 studies utilized CDT with or without ultrasound-assisted thrombolysis. The post-therapy pooled mean change of RV/LV ratio was -0.3 (95% confidence interval [CI]: -0.42, -0.18), and the pooled mean decrease of pulmonary artery pressure was -19.41 (95% CI: -27.65, -11.17) mm Hg. Safety outcome analysis demonstrated low pooled rates of adverse events (in-hospital mortality: 0.00 [95% CI: 0.00, 0.01]; 30-day mortality: 0.00 [95% CI: 0.00, 0.03]; major bleeding: 0.00 [95% CI: 0.00, 0.02]; minor bleeding: 0.05 [95% CI: 0.01, 0.12]).

Conclusions: This meta-analysis demonstrates evidence of therapeutic efficacy and low rates of adverse events of catheter-directed interventions in submassive PE.