Carin F Gonsalves | PEERLESS randomized controlled trial: Subanalysis of pulmonary embolism

Carin F Gonsalves, Thomas Jefferson University Hospital, United States Title: PEERLESS randomized controlled trial: Subanalysis of pulmonary embolism patient characteristics and outcomes by type of catheter-directed thrombolysis ABSTRACT: Purpose: To assess the impact of treatment variations on pulmonary embolism (PE) outcomes among patients assigned to catheter-directed thrombolysis (CDT) in the PEERLESS1 randomized controlled trial. Materials and Methods: All patients in the PEERLESS CDT arm were eligible for post hoc analysis2,3, except those treated with multiple CDT devices (n=8), non-tPA thrombolytics (n=10), or pharmacomechanical CDT (n=12). Patients were stratified by treatment: ultrasound-accelerated thrombolysis (USAT) or standard CDT (SCDT). Treatment protocols were reviewed, and clinical, safety, and quality-of-life outcomes were compared at discharge, 24 hours, 7 days, and/or 30 days. Results: A total of 159 patients underwent USAT and 87 underwent SCDT. Compared with the USAT group, the SCDT group had a longer mean treatment duration (20.8 vs 12.4 hours, p 0.001), a higher median thrombolytic dose (22 vs 16 mg tPA, p 0.001), and more ICU stays lasting 24 hours (80.5% vs 57.4%, p 0.001). Despite these differences, in-hospital outcomes were similar between groups, including all-cause mortality (1.1% vs 0.0%, p=0.35), intracranial hemorrhage (0.0% vs 0.6%, p=1.00), major bleeding (10.3% vs 5.7%, p=0.20), and clinical deterioration and/or bailout (5.7% vs 5.0%, p=0.77). At 24 hours, there were no significant differences in RV/LV ratio reduction (23.1% vs 19.9%, p=0.10) or respiratory rate (19.9 vs 20.0 breaths/min, p=0.62). At 30 days, quality-of-life measures were also comparable, including PEmb-QoL scores (23.0 vs 18.5, p=0.18) and EQ-5D-5L scores (0.81 vs 0.84, p=0.85). Conclusion: Although differences were observed in CDT treatment type, duration, and thrombolytic dose, clinical outcomes did not differ significantly between USAT and SCDT. These findings suggest that the primary PEERLESS trial results are generalizable across a range of real-world CDT treatment protocols. REFERENCES: 1.Jaber WA, Gonsalves CF, Stortecky S, et al. Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in the Management of Intermediate-Risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial. Circulation (New York, NY). 2025;151(5):260-273. doi:10.1161/CIRCULATIONAHA.124.072364 2. Gonsalves C, Jaber W, Stortecky S, Gibson C. Abstract No. 164 Exploratory Subanalysis of Pulmonary Embolism Population Characteristics and Outcomes by Type of Catheter-Directed Thrombolysis in the PEERLESS Randomized Controlled Trial. Journal of vascular and interventional radiology. 2025;36(3):S75-S75. doi:10.1016/j.jvir.2024.12.207 3. Gonsalves CF, Stortecky S, Horr S, et al. Evaluation of Catheter-Directed Thrombolysis Device Type and Dosing on Treatment Outcomes in Intermediate-Risk Pulmonary Embolism: A PEERLESS Randomized Controlled Trial Post Hoc Analysis. Journal of vascular and interventional radiology. 2026;37(1). doi:10.1016/j.jvir.2025.09.037 #WCCRT2026 #cancerresearch #cancertherapy #oncology #CancerConference #medicalconferences #healthcareinnovation #cancerawareness #immunotherapy #precisionmedicine #cancertreatment #oncologyresearch #globalhealth #medicalscience #cancercare #cancercommunity #cancerbreakthrough #lifesciences #clinicalresearchcoordinator #oncologista #oncologie #cancer #cancertarot #cancerawareness #oncologyresearch #medicaloncology #radiationoncology #surgicaloncology #pediatriconcology #oncologycare #oncologyinnovation #oncologyexperts #cancerbiology #molecularoncology #targetedtherapy #CancerImmunology #oncologynursing #CancerEpidemiology #OncologyAdvances #cancerprevention #earlydetection #cancerscreening #oncologyeducation