Episode # 53 • 22 Sept 2026
Pulmonary Embolism: Catheter-Based Therapy & Importance of Blood Return
As new guidelines redefine risk stratification for pulmonary embolism (PE), emerging technologies are also changing what it means to achieve procedural success. On this episode of the BackTable Podcast, interventional radiologist Dr. Julie Bulman (BIDMC) and interventional cardiologist Dr. Jay Giri (Penn Medicine) join host Dr. Chris Beck to discuss the evolving frameworks and technologies redefining standards for catheter-directed treatment of intermediate- and high-risk PE. They discuss the role of multidisciplinary PERT teams, patient selection, the impact of new thrombectomy devices, and why autologous blood return is a growing consideration for procedural success.
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Timestamps
00:00 - Introduction
03:42 - Referral Patterns and PERT Scope
05:25 - PE Workup Essentials
07:26 - Targeted Assessment of Acuity
11:36 - Reliability of the Walk Test
14:35 - PE Treatment Pathways
19:26 - Procedural Walkthrough
24:15 - Catheter Sizing
30:05 - Adjunct Aspiration Device Features
35:09 - Blood Return Process and Safety
40:03 - Helo Study Early Results
45:09 - Determining Procedural Endpoints
50:20 - Future Trials and Technologies
53:48 - Final Thoughts and Closing Remarks
Resources
- 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults
- Ultrasound-Facilitated, Catheter-Directed Thrombolysis in Intermediate-High Risk Pulmonary Embolism (HI-PEITHO)
- PEERLESS II study
- Catheter-Directed Thrombolysis in Intermediate-High–Risk Pulmonary Embolism (PRAGUE-26)
- Pulmonary Embolism International THrOmbolysis Study-3 (PEITHO-3)
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More about this episode
The discussion highlights how PERT teams use updated guidelines and thorough clinical evaluation to guide patient classification and treatment pathway selection. Dr. Bulman and Dr. Giri outline their criteria for choosing anticoagulation, catheter-directed lysis, or mechanical clot removal, and compare the techniques and learning curves for medium- versus large-bore thrombectomy devices. They explore the significance of autologous blood return during aspiration thrombectomy, noting how new reinfusion systems can reduce blood loss and influence procedural decision-making. Dr. Bulman also presents early Helo Thrombectomy System study data demonstrating the benefits of mechanized aspiration with minimal complications. The episode closes with a critical look at defining true functional procedural endpoints beyond pulmonary arterial pressures and offers a preview of upcoming trial data, such as HI-PEITHO and PEERLESS II, that could further advance PE management.
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