Safety and efficacy of thrombolysis with the EkoSonic Endovascular System for intermediate-high risk pulmonary embolism during on- and off-hours: a multicenter study.

backgroundCatheter-directed thrombolysis using the EkoSonic™ Endovascular System (EKOS) is an established therapy for intermediate-high risk (IHR) pulmonary embolism (PE). However, whether the timing of intervention, during regular working hours (RW) versus (vs.) on duty hours (OD), impacts safety and efficacy outcomes remains unclear.

methodsWe retrospectively analyzed consecutive patients with IHR-PE treated with EKOS-lysis at three German centers between 08/2020 and 12/2023. Patients were grouped by timing into RW and OD group, based on institutional definitions of working hours. The primary endpoint was procedural safety, including in-hospital mortality of any cause and bleeding/non-bleedings complications. Secondary outcome compromised echocardiographic efficacy parameters, including reduction in right ventricular to left ventricular (RV/LV) ratio, systolic pulmonary artery pressure (sPAP), and improvement in tricuspid annular plane systolic excursion (TAPSE).

resultsOf 154 patients, 99 procedures were performed during RW hours, while 55 were done during OD hours. Baseline characteristics were comparable in both groups. Door-to-EKOS time (20.6 (4.8; 44) h vs. 7.2 (4,1; 19) h; p = 0.012) and CT-EKOS time (6.4 (1.3; 20) h vs. 2.3 (1.4; 3.5) h; p = 0.002) were significantly shorter during OD. Overall complication rates were lower OD (20 (20.2%) vs. 4 (7.3%); p = 0.038), with fewer bleeding events (18 (18.2%) vs. 3 (5.5%); p = 0.029). In-hospital mortality was similar (RW 8 (8.1%) vs. OD 2 (3.6%); p = 0.496). Both groups showed significant improvement in echocardiographic parameters with no significant intergroup differences in treatment efficacy.

conclusionEKOS-lysis performed during OD hours is safe and effective, with even fewer complications than during RW hours. These findings support the feasibility and safety of continuous PE-care by an experienced Pulmonary Embolism Response Team irrespective of procedural timing.