CAVT With Anticoagulation Substantially Reduces RV/LV Diameter Ratio in PE, With Rachel Rosovsky, MD

Results from the STORM-PE trial have highlighted the superior efficacy of computer-assisted vacuum thrombectomy (CAVT) with anticoagulation (AC) in reducing right-to-left-ventricular (RV/LV) diameter ratio within 48 hours compared to AC alone in patients with intermediate to high risk of pulmonary embolism (PE).1

The elevated RV/LV diameter ratio characteristic of PE can often result in early clinical decompensation and mortality. The disease affects 1 in 1000 adults worldwide annually, reflecting a substantial reduction to quality of life. AC alone has long been considered the core of PE treatment, but growing evidence endorses endovascular therapy coupled with AC as a safe and effective method of reducing the RV/LV ratio. STORM-PE is the first randomized clinical trial to test the efficacy and safety of a mechanical thrombectomy against AC.1

The editorial team at HCPLive sat down with Rachel Rosovsky, MD, a hematologist and clinical investigator at the Massachusetts General Hospital and associate professor at Harvard Medical School, to discuss the function of CAVT and how it stands to revolutionize PE treatment.

“The CAVT is mechanical tech from Penumbra, used to remove blood clots from arteries and veins,” Rosovsky told HCPLive. “What makes it unique is that it’s a minimally invasive procedure, and it uses a computer-powered algorithm to enable it to quickly detect what is clot and what’s not and then remove the clot and minimize blood loss. And in our study, we found that it was a safe and fast procedure.”

STORM-PE was a prospective, randomized, placebo-controlled trial conducted over 22 locations globally. For inclusion, patients were required to have clinical signs and symptoms of acute PE with a duration of ≤14 days, objectively confirmed acute PE based on computed tomographic pulmonary angiography (CTPA), and a classification of intermediate high-risk PE as demonstrated by right ventricular dysfunction RV/LV ratio ≥1 on CTPA, among other requirements. Exclusion criteria included hemodynamic instability with cardiac arrest, obstructive shock, or persistent hypotension and allergy-, hypersensitivity-, or heparin-induced thrombocytopenia.2

A total of 100 patients were included in the trial and were randomly assigned in a 1:1 ratio to either CAVT (n = 47) or AC (n = 53). The mean age was 59.5 +/- 13.22 years in the CAVT arm and 61.2 +/- 14.19 years in the AC arm. The mean time from symptom onset to PE hospital admission was 3 days (interquartile range [IQR] 0-6) in the CAVT arm and 2 days (0-6) in the AC arm (P = 0.889). All patients had elevated cardiac biomarkers, and 59.1% in the CAVT arm and 74.5% in the AC arm had both elevated troponin and BNP or NT-proBNP.1

After 48 hours, the CAVT arm saw a significantly greater change in RV/LV ratio (0.52 +/- 0.37 vs 0.24 +/- 0.4), with a difference of 0.27 (95% CI, 0.12-0.43; P <.001). CAVT treatment also resulted in earlier normalization of vital signs, and there was little difference in major adverse events across both arms (CAVT 4.3% vs AC 7.5%; P = .681).1

“I think that this is a game changer,” Rosovsky said. “This is a groundbreaking trial. It really allows patients to think about an alternative or additional therapy that can really help them feel better and improve faster.”

Editor’s Note: Rosovsky reports disclosures with BMS, Janssen, Dava, and Inari Medical.

References

1. Lookstein RA, Konstantinides SV, Weinberg I, et al. Randomized controlled trial of mechanical thrombectomy with anticoagulation versus anticoagulation alone for acute intermediate-high risk pulmonary embolism: Primary outcomes from the storm-PE trial. Circulation. Published online November 3, 2025. doi:10.1161/circulationaha.125.077232

2. Penumbra Inc. Comparison of Two Pulmonary Embolism Treatments. ClinicalTrials.gov Identifier: NCT05684796. Updated November 17, 2025. Accessed November 25, 2025. https://clinicaltrials.gov/study/NCT05684796