For high-risk PE in people who cannot have thrombolysis, or when there are no other suitable treatment options or alternative treatments have failed, percutaneous thrombectomy should only be used with special arrangements for clinical governance, informed consent and audit. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wanting to do percutaneous thrombectomy for high-risk PE when alternative treatments are not suitable should:
Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
For intermediate-risk PE or high-risk PE when alternative treatments are suitable, pulmonary thrombectomy should only be used in research. Find out what only in research means on the NICE interventional procedures guidance page.
Further research should be in the form of randomised controlled trials or registries. It should report:
patient selection
size and position of the clot
degree of right ventricular dysfunction
details of the procedure, including the device used
short- and long-term outcomes, including patient-reported outcomes.
There is enough evidence that the procedure reduces the extent of clot in the circulation but not enough evidence of improvement in short- and long-term outcomes. The evidence on safety does not raise any major concerns. Most of the evidence is for intermediate-risk PE. There is no evidence from randomised controlled trials and very little long-term follow-up evidence, particularly for patient-reported outcomes.
There is an unmet need for people with high-risk PE when alternative treatments are not suitable or have failed, and this procedure is the only treatment option. So, this procedure is recommended for use with special arrangements for this population.
Because of the lack of evidence, this procedure is only recommended for use in research for intermediate-risk PE, or high-risk PE when alternative treatments are suitable.