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ACVC 2026 | Not all high risk pulmonary embolism is equal. A key message from #ACVC26: 👉 High risk PE is not a single entity, there is major heterogeneity in presentation, physiology, and response to therapy. ⚠️ Guidelines vs real-world complexity According to ESC 2019: • Immediate anticoagulation • Systemic thrombolysis → first-line therapy (Class I, Level B) • Surgical embolectomy → second-line • Catheter-directed therapy (CDT) → third-line ➡️ However, this linear model does not reflect clinical reality 🚨 Limitations of systemic thrombolysis Key concerns highlighted: • Not always fast enough in critical patients • Variable effectiveness on clot burden • Significant bleeding risk • Many patients have contraindications 📊 Important insight: 👉 Up to ~1/3 of PE patients have contraindications to fibrinolysis ➡️ Leading to underuse even in eligible cases 🧠 Not all high-risk PE behaves the same New paradigm (AHA/ACC 2026): High-risk PE spectrum includes: • D1 → transient hypotension • D2 → normotensive shock • E1 → persistent hypotension • E2 → refractory shock / cardiac arrest ➡️ Particularly important: Normotensive shock = high risk despite “normal BP” 🔄 Treatment failure must be anticipated Clinical warning: • Lack of improvement within 24–48h after anticoagulation • No response 2–4h after thrombolysis ➡️ Should trigger escalation ⚙️ Catheter-directed therapies (CDT) Emerging central role: • Can be used early in selected patients • Especially when: Thrombolysis contraindicated Thrombolysis failure Rapid deterioration Algorithm highlights: • Early CDT after indication established • Can follow systemic thrombolysis if insufficient response • Requires PERT-based decision making. 🚀 Mechanical thrombectomy (CAVT) Highlighted as a promising strategy: Advantages: • Rapid clot removal • Immediate hemodynamic improvement • Lower bleeding risk vs systemic lysis Potential benefits of medium-bore devices: • Better distal reach • Lower vascular complications • Faster procedures • Reduced blood loss 🎯 Beyond pulmonary embolism CAVT applications extend to: • STEMI with high thrombus burden • Peripheral arterial embolism • Deep vein thrombosis • Ischemic stroke ➡️ Suggesting a broader paradigm shift in thrombosis management 🎯 Take-home message High-risk PE is not uniform. • Risk stratification must be dynamic • Normotensive shock is critical to recognize • Thrombolysis is not always sufficient or safe • Early escalation and device-based therapies are key 👉 We are moving from a “one-size-fits-all” to a personalized, physiology-driven approach #ACVC26 #PulmonaryEmbolism #InterventionalCardiology #CriticalCare #Thrombectomy #Shock #ESC

El exterminio de pingüinos 🐧 y otras especies de #Chile tendrá nombre y apellido. Sería un documental para la historia oscura de #Chile 🇨🇱