Catheter-Directed Mechanical Thrombectomy without Thrombolysis for Intermediate-to-High-Risk Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis.

purposeThis study aimed to evaluate the safety and efficacy of catheter-directed mechanical thrombectomy without adjunctive thrombolysis in patients with intermediate-to-high-risk acute pulmonary embolism. MATERIALS AND

methodsA systematic review was performed across PubMed, Embase and the Cochrane Library until January 21, 2026. We included studies with intermediate-to-high-risk pulmonary embolism patients that underwent mechanical thrombectomy without thrombolysis. Continuous outcomes were analyzed using means and binary outcomes using proportion of events ratios, each with corresponding 95% confidence intervals. All analyses were performed using R software (version 4.4.1).

resultsA total of 13 studies comprising 1001 patients were included. The pooled rate of major bleeding was 2.39% (95% CI 1.20-3.58). In-hospital mortality occurred in 0.38% of patients (95% CI 0.00 to 1.00), and 30-day all-cause mortality was 0.72% (95% CI 0.00-1.49). Mean reduction in right ventricle-to-left ventricle ratio was 0.42 (95% CI 0.38-0.46). The mean intensive care unit and hospital length of stay were 1.96 days (95% CI 1.22-2.70) and 5.41 days (95% CI 4.48-6.34), respectively. Subgroup analyses suggested that higher bleeding and mortality rates were associated with higher-risk populations and smaller catheter sizes, although differences were not statistically significant.

conclusionThis meta-analysis suggests that catheter-directed mechanical thrombectomy without thrombolysis for intermediate-to-high-risk pulmonary embolism is associated with low rates of bleeding and mortality, improvements in hemodynamic parameters and short hospital and intensive care unit stays.