Large-Bore Thrombectomy Versus Catheter-Directed Thrombolysis for Acute Intermediate & High-Risk Pulmonary Embolism: A Meta-Analysis of Up-to-Date Evidence
Corresponding Author
Farhan Naeem
Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Correspondence: Farhan Naeem ([email protected]; [email protected])
Search for more papers by this authorUsama Qamar
Department of Internal Medicine, Mayo Clinic, Rochester, New York, USA
Search for more papers by this authorHadiah Ashraf
Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
Search for more papers by this authorShehroze Tabassum
Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
Search for more papers by this authorRamesh Daggubati
Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
Search for more papers by this authorM. Chadi Alraies
Department of Cardiology, Department of Medicine, Detroit Medical Center, Detroit, Michigan, USA
Search for more papers by this authorHafeez Ul Hassan Virk
Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorCorresponding Author
Farhan Naeem
Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Correspondence: Farhan Naeem ([email protected]; [email protected])
Search for more papers by this authorUsama Qamar
Department of Internal Medicine, Mayo Clinic, Rochester, New York, USA
Search for more papers by this authorHadiah Ashraf
Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
Search for more papers by this authorShehroze Tabassum
Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
Search for more papers by this authorRamesh Daggubati
Department of Cardiology, West Virginia University, Morgantown, West Virginia, USA
Search for more papers by this authorM. Chadi Alraies
Department of Cardiology, Department of Medicine, Detroit Medical Center, Detroit, Michigan, USA
Search for more papers by this authorHafeez Ul Hassan Virk
Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
Search for more papers by this authorFarhan Naeem and Usama Qamar contributed equally to this manuscript.

Open Research
Data Availability Statement
Data for this meta-analysis were obtained from publicly available observational studies and randomized controlled trials, as cited in the included references.
References
- 1S. V. Konstantinides, G. Meyer, C. Becattini, et al., “2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism Developed in Collaboration With the European Respiratory Society (ERS): The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC),” European Respiratory Journal 54, no. 3 (2019): 1901647, https://doi.org/10.1183/13993003.01647-2019.
- 2A. Graif, K. D. Patel, N. J. Wimmer, et al., “Large-Bore Aspiration Thrombectomy Versus Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Propensity Score–Matched Comparison,” Journal of Vascular and Interventional Radiology 31, no. 12 (2020): 2052–2059, https://doi.org/10.1016/j.jvir.2020.08.028.
- 3M. J. Page, J. E. McKenzie, P. M. Bossuyt, et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” BMJ 372 (2021): n71, https://doi.org/10.1136/bmj.n71.
- 4E. D. Avgerinos, A. Abou Ali, C. Toma, et al., “Catheter-Directed Thrombolysis Versus Suction Thrombectomy in the Management of Acute Pulmonary Embolism,” Journal of Vascular Surgery: Venous and Lymphatic Disorders 7, no. 5 (2019): 623–628, https://doi.org/10.1016/j.jvsv.2018.10.025.
- 5R. Feroze, S. Arora, N. Tashtish, et al., “Comparison of Large-Bore Thrombectomy With Catheter-Directed Thrombolysis for the Treatment of Pulmonary Embolism,” Journal of the Society for Cardiovascular Angiography & Interventions 2, no. 1 (2023): 100453, https://doi.org/10.1016/j.jscai.2022.100453.
- 6A. Graif, K. D. Patel, N. J. Wimmer, et al., “Large-Bore Aspiration Thrombectomy Versus Catheter-Directed Thrombolysis for Acute Pulmonary Embolism: A Propensity Score-Matched Comparison,” Journal of Vascular and Interventional Radiology 31, no. 12 (2020): 2052–2059, https://doi.org/10.1016/j.jvir.2020.08.028.
- 7E. K. Inci, S. Khandhar, C. Toma, et al., “Mechanical Thrombectomy Versus Catheter Directed Thrombolysis in Patients With Pulmonary Embolism: A Multicenter Experience,” Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions 101, no. 1 (2023): 140–146, https://doi.org/10.1002/ccd.30505.
- 8W. A. Jaber, C. F. Gonsalves, S. Stortecky, et al., PEERLESS Committees and Investigators, “Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in the Management of Intermediate-Risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial,” Circulation 151 (2025): 260–273, https://doi.org/10.1161/CIRCULATIONAHA.124.072364.
- 9M. Ismayl, A. Ismayl, D. Hamadi, A. Aboeata, and A. M. Goldsweig, “Catheter-Directed Thrombolysis Versus Thrombectomy for Submassive and Massive Pulmonary Embolism: A Systematic Review and Meta-Analysis,” Cardiovascular Revascularization Medicine 60 (2024): 43–52, https://doi.org/10.1016/j.carrev.2023.10.002.
- 10A. Abrahamian, W. Khokher, R. Ahmad, et al., “Catheter-Directed Thrombolysis Versus Mechanical Thrombectomy in Treatment of Acute Pulmonary Embolism: A Systemic Review and Meta-Analysis of Dual Arm Studies,” Chest 164, no. 4 (2023): A5245–A5246, https://doi.org/10.1016/j.chest.2023.07.3401.
10.1016/j.chest.2023.07.3401 Google Scholar
- 11J. Giri, A. K. Sista, I. Weinberg, et al., “Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association,” Circulation 140, no. 20 (2019): e774–e801, https://doi.org/10.1161/cir.0000000000000707.