Pulmonary Embolism: Studies Chart Gaps in Care but Also Progress

MUNICH, Germany—Despite a dramatic rise in thrombectomy for pulmonary embolism (PE) in recent years, female patients in the United States with PE are less likely than their male peers to receive the therapy, according to nationwide data released today at the first-ever European Association for Percutaneous Cardiovascular Interventions (EAPCI) Summit.

“In the past, women have been historically less likely to receive thrombectomy, and there has been conflicting evidence on whether they are more or less likely to have complications from thrombectomy,” said Brett Cohen, MD (St. Luke’s University Health Network - Bethlehem, PA), who presented findings from the EQUITY-PE study.

Cohen told TCTMD that the study, by virtue of being retrospective, can’t reveal why women are less apt to receive thrombectomy.

“I believe it’s multifactorial, with one driving factor being the use of male sex as a risk factor for severity in some algorithms” such as the Pulmonary Embolism Severity Index, or PESI, “[which] are sometimes used as one aspect of determining who is eligible for intervention,” he said. Yet some studies have shown women with PE “are slightly less likely to have chest pain and hemoptysis but more likely to have severe symptoms which would point towards thrombectomy being the right choice.”

Systemic bias, though, could be a contributing factor, he said.

Generally speaking, “women have a history of worse cardiovascular outcomes and lower detection of conditions across a range of cardiovascular diseases, and that is likely playing a role in this as well,” Cohen suggested, adding that this is “hopefully decreasing in our national health system over time.”

The moderated ePoster session also offered additional abstracts that shed light on what thrombectomy offers PE patients, and hint at how it does so.

Signs of a Sex Gap

Cohen and colleagues culled data from the Nationwide Inpatient Sample for nearly 3 million patients hospitalized with acute PE between 2016 and 2022. Just 46,770 of those patients—1.6%—underwent thrombectomy.

The patients who underwent thrombectomy were more likely to be men versus women (53.3% vs 46.7%; P < 0.001). On average, they were healthier than those who didn’t have the intervention, with a lower Charlson Comorbidity Index, and were more likely to be treated at large hospitals. Use of the therapy increased by sixfold over the years for both sexes, sharply accelerating during the COVID-19 era, though it remained consistently lower for women

Among the subset of PE patients with cor pulmonale, thrombectomy rates rose from 3.17% to 22.43% among male patients and from 2.45% to 19.84% among female patients. Complications occurred at similar rates in both sexes apart from a higher CPR rate among women (5.48% vs 3.68% among men; P = 0.009). Female patients showed a nonsignificant trend towards higher mortality as well (6.87% vs 5.41%; P = 0.062).

But as Cohen pointed out, mortality is not the only endpoint of interest. This point was driven home by data from two additional studies: STRIKE-PE and STORM-PE. Both are testing the Lightning computer-assisted vacuum thrombectomy (CAVT) system (Penumbra).

STRIKE-PE

Aleksander Araszkiewicz, MD, PhD (Pozman University of Medical Sciences, Poland), presented an interim analysis of the first 595 patients (mean age 61.9 years; 52.9% male) in the single-arm STRIKE-PE trial to be treated with CAVT. The trial is slated to enroll up to 1,500 patients across 80 international sites.

Median times for thrombectomy and the procedure as a whole were 30 and 61 minutes, respectively. Nearly half (47.7%) had no ICU stay thereafter, and of those who did, the median ICU stay was 2 days. The median hospital length of stay was 5 days.

The primary performance endpoint of RV/LV ratio was 1.37 at baseline and 0.97 at 48 hours, a decrease of 26.7% (P < 0.001). Composite major adverse events, the primary safety endpoint, occurred in 1.8% of patients. In all, 1.8% experienced major bleeding, 0.3% had device-related clinical deterioration, and 0.2% had device-related pulmonary injury. There were no device-related deaths or cardiac injuries.

Functional outcomes also were positive. By 90 days, there were significant improvements in the Borg Dyspnea Scale at rest and after 6-minute walk test, 6-minute walk distance, EQ VAS and EQ-5D-5L values, the total and various dimensions of PEmb-QoL, and NYHA class. These gains were maintained through 1 year.

STORM-PE

For the STORM-PE randomized trial of 100 patients, whose main results were released at TCT 2025, Grzegorz Kopeć, MD, PhD (Jagiellonian University Medical College, Krakow, Poland), shared additional findings at EAPCI 2026 that may provide clues to the mechanism behind CAVT’s impact on RV/LV ratio.

Thrombus burden, quantified as mean Refined Modified Miller Score (RMMS), decreased 2.7 times more between baseline and 48 hours in the study’s CAVT arm compared with its anticoagulation alone arm, with relative reductions of 42.1% and 15.6%, respectively (P < 0.001). Mean values for heart rate at 48 hours, National Early Warning Score 2 (NEWS2) at 48 hours, 6-minute walk distance at 30 and 90 days, and post-venous thromboembolism functional status (PVFS) from baseline to discharge also favored CAVT.  By 48 hours, fewer patients had tachycardia after CAVT compared with anticoagulation (2.2% vs 20.0%; P = 0.008).

The results confirm that “CAVT is an effective treatment strategy for acute intermediate-high-risk PE,” said Kopeć.