Mechanical Thrombectomy for High-Risk Pulmonary Embolism on ECMO: A Single-Center Retrospective Case Series.

PURPOSE: To evaluate the use of mechanical thrombectomy (MT) in patients who require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for the management of acute high-risk pulmonary embolism. MATERIALS AND METHODS: This retrospective case series included patients who underwent VA-ECMO followed by MT for the treatment of pulmonary embolism between January 2017 and December 2025. Clinical, laboratory, and imaging data were collected from the electronic medical record. Outcomes included 30-day mortality and procedural complications. Potential risk factors for mortality were evaluated. Exploratory analyses between survivors and non-survivors were performed using the Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables. RESULTS: A total of 20 patients met inclusion criteria. The mortality rate was 15% (n=3) at 48 hours, 35% (n=7) at 30 days, and 45% (n=9) at six months. Procedure-related complications were present in 45% (n=9) of patients. Acute bleeding events occurred in 30% (n=6) of patients, and neurologic events occurred in 15% (n=3) of patients following ECMO cannulation and MT. No variables evaluated were significantly associated with mortality. CONCLUSION: In this single-center retrospective cohort, patients undergoing MT while supported with VA-ECMO for high-risk pulmonary embolism demonstrated a 30-day mortality of 35%. Further studies including matched controls and larger cohorts are needed to better define the role of MT in this critically ill population.

Duke Scholars

Author Eric Mastria Radiology, Interventional Radiology

Author Jonathan Martin Radiology, Interventional Radiology

Author Brian Prescott Triana Radiology, Interventional Radiology