Role of catheter-based interventions in treating pulmonary embolism

Table 2 Catheter-based interventions for pulmonary embolism

Therapy type	Key devices	Mechanism of action	Evidence and trials	Benefits	Complications/risks
CDT	Standard/perforated infusion catheters (Uni-Fuse, Cragg-McNamara)	Local thrombolytic drug infusion into thrombus	Supported by ULTIMA, SEATTLE II, OPTALYSE PE	Lower bleeding risk than systemic thrombolysis	Requires prolonged infusion, potential bleeding
Ultrasound-assisted thrombolysis	EKOS (EkoSonic)	Ultrasound energy enhances thrombolytic penetration	Same trials as CDT, plus KNOCOUT PE, SUNSET sPE	Effective RV-to-left ventricle ratio reduction, low bleeding	Variable efficacy vs standard catheter-directed thrombolysis, longer duration
Mechanical thrombectomy-FlowTriever	FlowTriever (Inari)	Aspiration with large-bore catheters and clot disruption tip	FLARE, FLASH registry	Immediate hemodynamic improvement, low mortality	Blood loss, procedural complexity
Mechanical thrombectomy-Indigo	Indigo system (Penumbra)	Automated aspiration using suction pump and separator wire	EXTRACT-PE, STRIKE-PE	Rapid improvement in RV strain, symptom relief	Device-related events (rare), training required
Pharmaco-mechanical thrombectomy	Combined use of thrombolytics and mechanical devices	Dual action: Clot lysis and mechanical removal	PEERLESS Trial	Improved outcomes over thrombolysis in some studies	Need for precise patient selection, limited long-term data

CDT: Catheter-directed therapy; RV: Right ventricular.