FlowTriever-based mechanical thrombectomy for non-traumatic pulmonary embolism: a systematic review and meta-analysis

Background. Pulmonary embolism (PE) is a life-threatening condition characterized by the obstruction of pulmonary arteries by blood clots. Despite advancements in diagnosis and treatment, PE remains a significant cause of morbidity and mortality worldwide. The FlowTriever system is a mechanical thrombectomy system designed specifically for the treatment of PE, consisting of a flexible catheter that captures and removes clots from the pulmonary arteries. Methods. A systematic review and single-arm meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, ScA systematic review and single-arm meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, Cochrane Library, and ProQuest were searched from inception to August 15, 2024. Prospective and retrospective clinical studies evaluating the FlowTriever system in adult patients with non-traumatic acute PE were included. Continuous outcomes were pooled as mean differences (MD) using random-effects models. Dichotomous outcomes, including short-term mortality and adverse clinical outcomes, analyzed as a composite endpoint, were pooled as event rates using random-effects proportional meta-analysis with logit transformation. Results. Six studies comprising 477 patients were included. Meta-analysis demonstrated a significant reduction in mean pulmonary artery pressure following FlowTriever thrombectomy (pooled MD −6.55 mmHg; 95% CI: −10.25 to −2.85), with moderate heterogeneity (I² = 61.9%). The pooled short-term mortality rate was 7% (95% CI: 1–37%; I² = 66.1%). The pooled rate of adverse clinical outcomes (composite endpoint) was 7% (95% CI: 2–27%), with substantial heterogeneity (I² = 84.4%). Narrative synthesis consistently demonstrated improvements in right ventricular function following intervention. Conclusion. FlowTriever mechanical thrombectomy is associated with significant hemodynamic improvement and low short-term mortality and adverse clinical outcome rates in patients with acute pulmonary embolism. These findings support the safety and effectiveness of FlowTriever thrombectomy in selected PE populations, while highlighting the need for randomized controlled trials to further define its role in clinical practice.