Reducing ICU utilization in acute PE: real-world experience with flowtriever thrombectomy

Abstract

Bacground: Pulmonary embolism (PE) is a life-threatening condition that often requires rapid reperfusion to prevent right-ventricular failure and prolonged intensive care stay. Modern percutaneous strategies such as catheter-directed thrombolysis (CDT) improve pulmonary pressures but are limited by bleeding risk and the frequent need for ICU monitoring to manage thrombolytic infusion. Mechanical thrombectomy has emerged as an alternative that provides faster hemodynamic improvement without thrombolytics.

Among these devices, the FlowTriever system has shown significant potential to reduce ICU utilization. The FLARE trial demonstrated that 41% of treated patients required no ICU stay, and the mean ICU duration was only 1.5 days. Real-world data from the FLASH registry similarly reported rapid clinical stabilization and low rates of ICU admission. Comparative observational studies also suggest shorter ICU stays with FlowTriever versus standard catheter-based therapies.

Aim

The aim of this study is to evaluate whether the FlowTriever mechanical thrombectomy system reduces ICU length of stay compared with other percutaneous treatment strategies for acute pulmonary embolism.

Methos/Results: We conducted a retrospective analysis of all patients treated for acute pulmonary embolism at our center between 2020 and 2025. A total of 159 patients were included, with a median age of 62 years (IQR ±16) and 48% women. Based on hemodynamic presentation, 9% were classified as high-risk PE, while the remainder met criteria for intermediate-high–risk PE. Patients were grouped according to the reperfusion strategy used: systemic fibrinolysis (n=99), combined fibrinolysis plus mechanical therapy (n=12), Penumbra thrombectomy (n=6), FlowTriever thrombectomy (n=37), and EKOS catheter-directed thrombolysis (n=5). The primary endpoint was ICU length of stay, measured in days and compared across treatment modalities.

Baseline characteristics were similar across treatment groups, with no statistically significant differences in age (p=0.95), sex distribution (p=0.25), high-risk presentation (p=0.301), syncope (p=0.766), or dyspnea (p=0.253). A higher proportion of cardiac arrest events was observed in the EKOS group, although this difference did not reach statistical significance (p=0.053).

In this cohort with acute pulmonary embolism, ICU length of stay varied significantly across reperfusion strategies (ANOVA F = 5.48; p < 0.001). FlowTriever was associated with the shortest ICU stay (2.78 days), followed by EKOS (3.1 days), fibrinolysis (3.42 days), combined therapy (3.7 days), and Penumbra (9 days).

Conclusion

FlowTriever demonstrated a consistent trend toward shorter ICU stays compared with other percutaneous techniques, suggesting a potential clinical advantage as well as economic and logistical benefits.For image description, please refer to the figure legend and surrounding text.