Catheter-directed thrombolysis significantly improves PE outcomes
New late-breaking data presented at ESC Congress 2026 adds to the growing evidence that more invasive catheter-based pulmonary embolism (PE) procedures improve patient outcomes.
The PRAGUE-26 study evaluated the efficacy and safety of catheter-directed thrombolysis in intermediate−high risk PE. The technology uses catheters to directly deliver blood clot-busting drugs into the thrombus lodged in the lungs. The study found that it improved short-term clinical outcomes compared to standard anticoagulation therapy alone.
Professor Viktor Kočka and Doctor Josef Kroupa, both from from Charles University and University Hospital Kralovske Vinohrady in Prague, Czechia, led the PRAGUE-26 study. They believe these results should be used to inform future guidelines to advocate for more aggressive treatment of PE. They added that changes in PE have been needed for quite some time.
“In contrast to interventions for myocardial infarction or stroke, there have been very few advances in the treatment of pulmonary embolism over the last 20 years," Kočka said in a statement. "This has led to a considerable unmet clinical need that we can’t ignore."
The study randomized 558 patients with acute intermediate−high risk PE 1:1 to receive catheter-directed thrombolysis (CDT) or standard anticoagulation therapy alone using intravenous, unfractionated heparin or subcutaneous low-molecular-weight heparin.
The primary endpoint was a composite of all-cause mortality, PE recurrence, or cardiorespiratory decompensation or collapse within seven days of randomization. Eleven sites in Czechia participated. The median age was 64 years old, and 41% of patients were women.
That endpoint significantly less common in the CDT group than it was in the standard-care group (0.7% vs. 6.8%). This difference was driven mostly by a lower rate of cardiorespiratory decompensation or collapse with CDT.
“The primary outcome finding was accompanied by early improvement in right ventricular strain on echocardiography, consistent with previous studies reporting favorable effects of CDT,” Kroupa said in the same statement.
There was no difference in bleeding events between the two cohorts within seven days. And there were two cases of intracranial bleeding in the CDT group and none in the standard-care group. Also, four deaths occurred in the standard-care group within seven days, and one death occurred in the CDT group within 30 days.
Implications to change PE guidelines
CDT is a simple and relatively inexpensive procedure that might greatly improve outcomes. In the same statement, Kočka suggested using the catheter percutaneous coronary interventions (PCI) blueprint already in place for heart attacks. He hopes the trial data will influence the new ESC guidelines on pulmonary embolism that are expected to be published next year.
"This may pave the way for an improved, standardized approach to the treatment of pulmonary embolism, reducing the acute risks that patients face,” Kočka explained.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]