The management of intermediate-high and high-risk pulmonary embolism (PE) remains an area of therapeutic uncertainty, particularly in patients with right ventricular (RV) dysfunction, in whom anticoagulation alone may be insufficient. In this context, the FLASH registry provides evidence regarding the role of mechanical thrombectomy (MT) using the large-bore FlowTriever system.
An analysis of the European cohort (N=200) was presented. This prospective multicenter registry included “all-comer” patients with intermediate and high-risk PE. Compared with the U.S. cohort, the European population included a significantly higher proportion of high-risk patients (40.4% vs 7.9%).
The primary endpoint (PEP) of major adverse events at 48 hours (MAE: device-related mortality, major bleeding at 48 hours, and device-related adverse events) was low (1.8%), with no device-related deaths reported. Overall mortality at 30 days was 5.2%, although clearly higher in the high-risk subgroup (9.3% vs 2.6%).
FLASH Registry Europe: Mechanical Thrombectomy With FlowTriever Achieves Rapid Hemodynamic Improvement and Low Adverse Event Rates in Pulmonary Embolism
From a hemodynamic perspective, significant immediate improvements were observed, including a reduction in mean pulmonary artery pressure (mPAP) of −7 mmHg, decreased pulmonary vascular resistance, and an increase in cardiac index, demonstrating a direct hemodynamic effect of the procedure.
Regarding safety, the rate of major bleeding was low (3.1%), with no increase in device-related complications. No deaths attributable to the system or serious device-related events were reported at 30 days.
A relevant finding was the impact on healthcare resource utilization: more than 50% of patients did not require intensive care unit admission following the procedure.
Conclusion: Mechanical Thrombectomy in Intermediate-High and High-Risk Pulmonary Embolism
In this European cohort, mechanical thrombectomy demonstrated a favorable safety profile and rapid hemodynamic improvement, with consistent clinical outcomes even among higher-risk patients. However, randomized trials currently underway (PEERLESS II and PERSEVERE) are still needed to define its role compared with standard treatment.
Presented by Ana Viana Tejedor at the Acute Cardiovascular Care Congress 2026, Lisbon, Portugal, March 20–21, 2026.
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 de riesgo intermedio-alto y alto continúa siendo un área de incertidumbre terapéutica, especialmente en pacientes con disfunción del ventrículo derecho (VD), en quienes la anticoagulación aislada puede resultar insuficiente.){kind=link}