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Mechanical Thrombectomy of Wall Adherant Thrombus and Post Thrombotic Syndrome Diagnosis: A comparison of PST free outcomes and the ATTRACT trial in literature review
Peter Stibbs*, Jeffrey Wells, Dileo Govantes, Lawrence Weller
Background: Post Thrombotic Syndrome (PTS) occurs in 23%-60% of Deep Venous Thrombosis (DVT) cases, representing a significant clinical and economic burden. The NIH-funded ATTRACT trial showed no significant difference in PTS diagnosis rates between Catheter Directed Thrombolysis (CDT) and oral anticoagulation alone. However, newer mechanical thrombectomy devices designed to remove wall adherent thrombus have emerged, raising questions about their efficacy in comparison to traditional treatments.
Objective: This study aims to compare PTS diagnosis rates in patients receiving percutaneous mechanical thrombectomy with extirpation of thrombus versus traditional pharmacological lysing of thrombus with oral anticoagulation. Methods: A retrospective review of 62 peer-reviewed publications was conducted, ultimately narrowing the focus to 12 studies with significant procedural volumes and commonality in reporting PTS after initial treatment methodology. Two mechanical thrombectomy devices, the ClotTriever (Inari Medical) and the Cleaner TM (Argon Medical), were identified for their design targeting wall adherent thrombus.
Results: Both the ClotTriever and Cleaner TM thrombectomy devices showed lower rates of PTS diagnosis at six months compared to CDT with oral anticoagulation alone, as cited in the ATTRACT trial. The ClotTriever device had a PTS-free rate of 716%, while the Cleaner TM device demonstrated 72.4% and 72% PTS-free rates in separate studies.
Conclusion: Mechanical thrombectomy devices engaging wall adherent thrombus yielded lower rates of post thrombotic syndrome diagnosis at six months compared to catheter directed thrombolysis. However, this study is limited by its retrospective nature and varying inclusion/exclusion criteria across studies. Future prospective comparisons with controlled settings are recommended to evaluate the efficacy of these devices in relation to CDT and oral anticoagulation.