Background: For patients with high-risk pulmonary artery embolism (PE), catheter-directed therapies pose a viable alternative treatment option to systemic thrombolysis or anticoagulation. Right now, there are multiple devices available which have been proven to be safe and effective in lower-risk settings. There is, however, little data comparing their efficacies in high-risk PE. Methods: We performed a retrospective, single-center study on patients with high-risk PE undergoing catheter interventional treatment. Patients receiving large-bore catheter thrombectomy were compared to patients receiving alternative treatment forms. Results: Of the 20 patients included, 9 received large-bore thrombectomy, and 11 received alternative interventional treatments. While the baseline characteristics were comparable between the two groups, periprocedural and in-hospital mortality tended to be significantly lower with large-bore thrombectomy when compared to other treatment forms (0 vs. 55% and 33 vs. 82%, p = 0.07 and 0.01, respectively). Conclusions: In this small, retrospective study, large-bore thrombectomy was associated with lower mortality as compared to alternative treatment forms. Future prospective research is needed to corroborate these findings.

Background: Angiographic signs of chronic thromboembolic pulmonary hypertension or disease (CTEPH/D) are frequently found during large-bore thrombectomy (LBT) in acute pulmonary embolism (PE). Data on the incidence of CTEPH/D signs and outcome after LBT are lacking. These angiographic signs are not equivalent to a confirmed diagnosis of CTEPH/D. Aims: To investigate the efficacy and safety of LBT in patients with acute PE and angiographic signs of CTEPH/D compared to patients without (N-CTEPH/D). Methods: In total, 250 patients from five centers (CTEPH/D = 98, N-CTEPH/D = 152) were retrospectively analyzed. Efficacy of LBT was assessed by comparing clinical, echocardiographic, and invasive data between the groups. Safety endpoints included periprocedural death, procedural complications, or bleeding defined as the need for blood transfusion or hemoglobin drop of at least 5 g/dl. Results: At baseline, the CTEPH/D group had higher systolic pulmonary artery pressure (sPAP) (CTEPH/D: 54 ± 14 mmHg, N-CTEPH/D: 49 ± 13 mmHg, p = 0.006). After LBT, right ventricular/left ventricular-ratio (CTEPH/D: − 0.30 ± 0.26, N-CTEPH/D: − 0.27 ± 0.32, p < 0.001 for both), sPAP (CTEPH/D: − 13 ± 8, N-CTEPH/D: − 11 ± 8 mmHg, p < 0.001 for both), heart rate (CTEPH/D: − 19 ± 20 beats/min, N-CTEPH/D: − 21 ± 15 beats/min, p < 0.001 for both) and respiratory rate (CTEPH/D: − 6 ± 6 respirations/min, N-CTEPH/D: by − 8 ± 7 respirations /min, p < 0.001 for both) were significantly reduced in both groups without significant differences. Peri-interventional safety was comparable between groups. Conclusion: LBT appears to be safe and effective in patients with acute PE and angiographic signs of CTEPH/D. Long-term effects should be further investigated. Graphical