Mechanical thrombectomy can improve cardiac index in patient
Patients with PE were enrolled in FLASH, a prospective, multicenter registry evaluating outcomes after percutaneous mechanical thrombectomy with the FlowTriever System (Inari Medical). The FlowTriever System is a percutaneous mechanical thrombectomy system that rapidly extracts thrombus for on-table hemodynamic restoration without requiring thrombolytics.

Among the first 250 patients with PE enrolled in FLASH, the mean age was 61 years, 52.4% were men and half had bilateral PE. Patients were risk stratified using current European Society of Cardiology (ESC) guidelines (n = 220 with cardiac index available), the simplified Pulmonary Embolism Severity Index (sPESI; n = 208 with cardiac index available) or Bova score (n = 201 with cardiac index available). Researchers measured cardiac index via right heart catheterization before and after thrombectomy. Patients were then categorized into low cardiac index and normal cardiac index groups, with the prevalence of low cardiac index determined for each risk group. Low baseline cardiac index was defined as less than 2 l/min/m2. An average of 20% of patients with PE in each of the low-risk tiers had low cardiac index prior to thrombectomy, regardless of the risk stratification method used.

This study suggests that many patients with pulmonary embolism who present as hemodynamically stable may be in subclinical shock due to low cardiac index. Moreover, mechanical thrombectomy may confer an immediate improvement in cardiac index for these patients.