Complications of catheter-directed interventions in acute pulmonary embolism: a narrative expert review with guidance on management
Year: 2026
Type: article
Abstract: Background and Objective: Catheter-directed interventions (CDI) for pulmonary embolism (PE) have emerged as alternatives to systemic thrombolysis for patients requiring reperfusion, enabling thrombus burden reduction through low-dose local thrombolysis or mechanical thrombectomy. Despite encouraging hemodynamic and clinical outcomes, procedure-specific complications are poorly characterized in the literature. This narrative review aims to synthesize the reported complications of CDI in acute PE and provide practical management strategies. Methods: A PubMed search covering 2014-2025, limited to articles published in English or Spanish, complemented by reference screening, identified randomized clinical trials and prospective or retrospective registries of CDI in acute PE reporting safety outcomes. These studies were used to construct a comprehensive overview of CDI-related complications, while additional registries, case reports, and case series were examined to describe rare events not captured by primary studies, as well as expert insights when evidence was insufficient or unavailable. Key Content and Findings: Complications of CDI in acute PE encompass a broad and heterogeneous spectrum including access-site complications, right-heart injury, pulmonary arterial lesions, catheter malfunction and mechanical complications, and hemodynamic deterioration. Their incidence varies considerably across studies, and the absence of standardized definitions or classifications limits accurate assessment of the true frequency and clinical impact of those adverse events. Conclusions: Based on the available evidence, this narrative expert review examines the spectrum of CDI-related complications in acute PE. It seeks to bridge the gap between innovation and safety by equipping clinicians and interventionalists with practical guidance for the recognition, prevention, and management of these adverse events.
Institutions: Hospital Clínico San Carlos, Instituto de Salud Carlos III, Research Institute Hospital 12 de Octubre, Centro de Investigación en Red en Enfermedades Cardiovasculares, Hospital Universitario 12 De Octubre, Centro de Investigación Biomédica en Red, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7128608087