Ultrasound-facilitated catheter-directed thrombolysis is associated with improved survival and reduces hospital stay in acute pulmonary embolism: a propensity score-matched analysis.

Background: Systemic thrombolysis for intermediate-high and high-risk pulmonary embolism (PE) is limited by major bleeding risk. Ultrasound-facilitated catheter-directed thrombolysis (USAT) enables targeted fibrinolysis with lower thrombolytic doses, but comparative effectiveness data are often confounded by selection bias. We aimed to evaluate the safety and efficacy of USAT versus conventional therapy (anticoagulation or systemic thrombolysis) in a propensity score-matched cohort of patients managed within a multidisciplinary Pulmonary Embolism Response Team (PERT) pathway. Methods: We performed a retrospective study of 230 consecutive patients within a multidisciplinary PERT pathway. Patients received USAT using the EkoSonic Endovascular System or conventional therapy consisting of anticoagulation or systemic lysis. One-to-one propensity score matching (PSM) was performed, adjusting for age, sex, Pulmonary Embolism Severity Index (PESI), chronic kidney disease, history of deep vein thrombosis, obesity, and baseline troponin. A doubly robust logistic regression (PSM plus regression adjustment) was used to account for residual imbalance in left heart failure. Results: PSM yielded 81 matched pairs. USAT was associated with significantly lower in-hospital mortality (2.5% Conclusions: USAT was associated with lower in-hospital mortality and shorter hospital stay compared with conventional therapy. USAT was also associated with fewer major bleeding events, whereas clinically relevant non-major bleeding was more frequent. Exploratory subgroup analysis in obese patients suggested a similar mortality signal.