Catheter-directed therapy improves pulmonary embolism outcomes

In patients with intermediate-high-risk pulmonary embolism, catheter-directed thrombolysis showed improvement in short-term clinical outcomes compared to standard anticoagulation therapy alone, as revealed in a study presented at ESC Congress 2026. Pulmonary embolism, which occurs when a clot blocks blood vessels in the lungs, can lead to reduced blood flow and increased heart strain, posing a life-threatening risk.

Researchers Viktor Kočka and Dr. Josef Kroupa from Charles University and University Hospital Kralovske Vinohrady in Prague, Czechia, led the PRAGUE-26 study to assess the potential benefits of an interventional strategy in treating pulmonary embolism. There has been limited advancement in pulmonary embolism treatment over the past 20 years compared to other conditions like myocardial infarction or stroke, resulting in a significant unmet clinical need, Kočka stated.

Catheter-directed thrombolysis (CDT) is an affordable procedure that delivers thrombolytic medications directly to the clot in the pulmonary artery via a catheter in the catheterization laboratory. The PRAGUE-26 trial aimed to determine if conventional CDT could enhance outcomes in intermediate-high-risk acute pulmonary embolism compared to standard anticoagulation therapy alone.

The primary endpoint measured a composite of all-cause mortality, pulmonary embolism recurrence, or cardiorespiratory decompensation within seven days of randomization. The study randomized 558 patients, with a median age of 64 years, into two groups: CDT or standard anticoagulation therapy. The CDT group experienced significantly reduced primary endpoint rates (0.7% vs. 6.8%) compared to the standard-care group (p < 0.001), primarily due to lower cardiorespiratory decompensation or collapse rates.

Early echocardiography findings showed improved right ventricular strain in the CDT group, consistent with previous studies. Safety-wise, there were no notable differences in bleeding events between the two groups within seven days, with only two intracranial bleeding cases in the CDT group and none in the standard-care group. One patient in the standard-care group died within seven days, while one death occurred in the CDT group within 30 days.

Kočka emphasized that this specialized interventional treatment could be delivered in tertiary care centers, potentially leading to an improved, standardized approach to pulmonary embolism treatment, reducing acute risks for patients. Future ESC Guidelines on pulmonary embolism, set to be published next year, may incorporate these trial findings to inform recommendations.