Written by Millie Cossé
This RCT of 100 patients with intermediate-high risk PE showed that mechanical thrombectomy plus anticoagulation was superior to anticoagulation alone in reducing RV/LV ratio and earlier normalization of vitals.
There’s a STORM brewin’
The authors of the STORM-PE trial randomized 100 hemodynamically stable patients with acute PE and elevated RV/LV diameter with elevated cardiac biomarkers to either anticoagulation (AC) alone or anticoagulation with computer-assisted vacuum thrombectomy (CAVT).
The primary outcome of this study was change in RV/LV ratio assessed by CTA at 48 hours post-procedure. The CAVT+AC group had greater reduction in RV/LV ratio (0.52±0.37) than the AC group (0.24±0.40), a difference of 0.27 (95%CI 0.12 to 0.43, P<0.001).
While increased RV/LV ratio correlates with an increased risk of mortality, it may not be enough to justify the increased cost and expertise needed to treat these otherwise hemodynamically stable patients. The authors promise a future publication focused on functional outcomes (e.g. 6-minute walk test, post VTE functional status scale, etc.), which I think will be very important in weighing risks and benefits of this procedure.
How will this change my practice?
When I have a hemodynamically stable patient with an acute PE in my critical access ED, I need more than a surrogate endpoint to recommend transfer for a procedure. I look forward to the next paper coming out, and in the meantime, I will continue to coordinate care closely with regional referral centers.
Source
STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes from the STORM-PE Trial. Circulation. 2025 Nov 3. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub ahead of print. PMID: 41183181.
