New 2026 PE Guidelines and Risk Categories
Updated AHA guidelines replaced low, intermediate, and high risk categories with categories A through E for precision, recommending catheter directed therapies for category C and considering them for category D1 or D2 patients.
HI-PEITHO: Catheter Directed Thrombolysis Reduces Decompensation
In 544 randomized intermediate risk PE patients, ultrasound facilitated catheter directed thrombolysis with EKOS reduced a seven day composite of death, decompensation, or recurrence to 4 percent versus 10 percent with anticoagulation alone, driven mainly by fewer decompensation events, with no increase in major bleeding.
OPTIMIZE 3D: Distal Microvascular Volume Response
CT based 3D reconstruction showed catheter directed thrombolysis significantly increased small and medium pulmonary venous volumes at 48 hours regardless of dose, while mechanical thrombectomy and anticoagulation alone produced no significant venous volume change.
Device Selection and Simplified Catheter Technique
Panelists favor catheter directed thrombolysis for diffuse clot burden and mechanical thrombectomy for high bleeding risk patients, describing a technique of double sticking the common femoral vein bilaterally to place EKOS catheters in about 15 to 20 minutes.
