Interpreting Emerging Evidence in Intermediate‑High Risk Pulmonary Embolism: Implications for Interventional Clinical Performance-Slides - STORM-PE: What Computer-Assisted Vacuum Thrombectomy (CAVT) Adds, Dr. Lookstein

Slides - STORM-PE: What Computer-Assisted Vacuum Thrombectomy (CAVT) Adds, Dr. Lookstein

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STORM-PE is the first completed randomized controlled trial comparing mechanical thrombectomy plus anticoagulation (CAVT) versus anticoagulation alone for acute intermediate-high-risk pulmonary embolism. In 100 randomized patients across 19 sites, the primary endpoint was change in RV/LV ratio at 48 hours, measured by blinded core lab adjudication. CAVT produced a significantly greater reduction in RV strain than anticoagulation alone: RV/LV ratio fell from 1.63 to 1.11 with CAVT versus 1.56 to 1.32 with anticoagulation, with a between-group difference in absolute reduction of 0.27 (P=0.001). Other early physiologic measures also improved more with CAVT, including thrombus burden (RMMS), heart rate, oxygen requirement, and NEWS2 score.<br /><br />Safety outcomes through 7 and 90 days were similar between groups. Composite major adverse events, rescue therapy, major bleeding, symptomatic recurrent PE, and mortality did not differ significantly. No device- or procedure-related deaths occurred, and procedural complications were rare; technical success was 100% in the CAVT arm.<br /><br />Functional outcomes favored CAVT. Patients had better improvement in PVFS (post-PE functional status), walked farther on the 6-minute walk test at 90 days, and achieved a greater proportion of predicted walking distance. Dyspnea scores at discharge were not significantly different.<br /><br />Overall, STORM-PE showed that adding mechanical thrombectomy to anticoagulation in intermediate-high-risk acute PE led to faster physiologic recovery and greater reduction in right ventricular dilation, without an observed safety penalty, supporting CAVT as a promising treatment strategy.

Keywords

STORM-PE

mechanical thrombectomy

anticoagulation

pulmonary embolism

right ventricular strain

RV/LV ratio

randomized controlled trial

intermediate-high-risk PE

functional outcomes

major bleeding