Acute pulmonary embolism (PE) is a life-threatening condition caused by the thrombo-embolic obstruction of pulmonary arteries, which often leads to haemodynamic instability, right ventricular failure, and potentially death. Patients with massive or high-risk PE are particularly vulnerable and may not respond to conventional treatments, necessitating the implementation of mechanical circulatory support. Here, we discuss recent advancements in the diagnosis and multidisciplinary management of patients with high-risk PE and highlight the need for rapid and personalized treatment strategies.

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: Despite advances in antihypertensive therapy, blood pressure (BP) control remains inadequate in many patients due to limited follow-up and insufficient medication titration. Methods: This single-centre, randomized controlled pilot trial was conducted at a tertiary academic hospital in Germany between 12/2023 to 09/2024. Sixty adults with uncontrolled hypertension (office BP >140/90mmHg despite antihypertensive medication) were randomized 1:1 to standard care or physician-led telemedical care. All participants performed home BP measurements twice daily using validated telemedical devices. The intervention group received structured biweekly calls for BP review and medication optimization. The control group continued care with their general practitioners. The primary endpoint was time in target range (TTR) over 6 months, defined as the percentage of home BP readings below guideline thresholds (<130/80 mmHg for age <65, <140/90 mmHg for age ≥65). Group comparisons used t-tests. The study was registered at CinlicalTrials.gov Identifier [NCT07049289]. Results: Fifty-six patients completed 6-month follow-up (mean age 61±13 years, 61% male). Baseline BP was 161±17/97±12 mmHg. At 6 months, systolic BP decreased by -15.0±9.8 mmHg in the intervention group vs. -4.0±8.7 mmHg in the control group (p<0.001). Mean systolic TTR was significantly higher in the telemedical care group (52.2±24.2% vs. 36.0±29.2%, p=0.028), as was diastolic TTR (59.0±31.0% vs. 37.1±34.4 %, p=0.016), and total TTR (42.9±27.5% vs. 24.8±29.7%, p=0.021). Measurement adherence was superior in the intervention group (83.2±15.4% vs. 70.5±25.9%, p=0.033). Conclusion: Physician-supported telemedical care significantly improved BP control and measurement adherence over 6 months. Larger trials are needed to assess long-term clinical outcomes.