Conversations in Interventional Cardiology - Ultrasound-Facilitated Catheter-Directed Thrombolysis vs. Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Results of the HI-PEITHO Randomized Clinical Trial-Conversations in Interventional Cardiology: Ultrasound-Facilitated Catheter-Directed Thrombolysis vs. Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Results of the HI-PEITHO Randomized Clinical Trial

Conversations in Interventional Cardiology: Ultrasound-Facilitated Catheter-Directed Thrombolysis vs. Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Results of the HI-PEITHO Randomized Clinical Trial

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Video Summary

The conversation focused on the HIGH-PYTHO trial, a major randomized study of ultrasound-facilitated catheter-directed thrombolysis (USCDT) with the ECOS system versus anticoagulation alone in acute intermediate-risk pulmonary embolism. Stavros Konstantinidis reviewed how the trial built on the earlier PYTHO study, which showed benefit from thrombolysis but had high bleeding and intracranial hemorrhage rates. HIGH-PYTHO aimed to preserve efficacy while improving safety.<br /><br />The trial enrolled 544 patients at 59 sites in the U.S. and Europe using enriched criteria to select sicker intermediate-risk patients. The primary 7-day composite endpoint—PE-related mortality, cardiorespiratory decompensation/collapse, or recurrent PE—occurred in 4.0% of the USCDT group versus 10.3% with anticoagulation alone. The benefit was driven mainly by less clinical deterioration. Major bleeding was low and not significantly different between groups, and there were no intracranial hemorrhages.<br /><br />Panelists emphasized that the trial likely applies to selected, higher-risk intermediate PE patients, not all-comers. They also discussed the NEWS score, which helped define decompensation and may become more useful in future PE practice. Mortality remained very low in both arms, and the speakers agreed that future trials are more likely to show benefits in clinical deterioration, function, quality of life, and long-term outcomes rather than mortality alone.

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Keywords

HIGH-PYTHO trial

ultrasound-facilitated catheter-directed thrombolysis

USCDT

acute intermediate-risk pulmonary embolism

ECOS system

anticoagulation alone

major bleeding

clinical deterioration