A Comparison of Aspiration Thrombectomy to Catheter-Directed Thrombolysis in Management of Paget-Schroetter Syndrome.

OBJECTIVE

Acute subclavian vein thrombosis secondary to thoracic outlet (Paget Schroetter Syndrome-PSS) may involve prompt clearing of thrombus from the subclavian vein by catheter directed thrombolysis (CDT) or aspiration thrombectomy (ASP). Our goal is to systematically compare the outcomes of CDT and ASP in the management of PSS.

METHODS

Consecutive PSS cases at a single institution from 2020 through 2025 were reviewed for management with CDT or ASP. Venograms were assessed for patency, stenosis, and subclavian post-thrombotic changes (PTC). PTC were graded by degree of luminal encroachment, and vessel irregularity: mild (less than 10%), moderate (10-50%) and severe (50-99%). Interventions were assessed: (1) within 1 week of procedure, (2) before subclavian vein decompression, (3) 2 weeks after subclavian vein decompression, and (4) patency at last venogram. Standardized outcomes were assessed.

RESULTS

110 patients with PSS were treated over 5 years. 54 met inclusion criteria: 28 CDT and 26 ASP. 1 week following procedure, re-thrombosis occurred in 1 (3.6%) CDT and 6 (23.1%) ASP (p<0.5). Failure to clear thrombosis occurred in 13.8%) ASP case. Composite of early thrombosis and procedural failure was higher in the ASP cohort. Prior to PSS surgery, occlusion was noted in 1 (3.6%) CDT and 8 (30.8%) ASP (p<0.05). PTC mild in 13 (46.4%) CDT and 5 (19.2%) ASP (p<0.05); moderate in 5 (17.9%) CDT and 5 (19.2%) ASP, severe in 9 (32.1%) CDT and 8 (30.8) ASP. At early follow up after PSS surgery, PTC was mild in 10 (43.5%) CDT and 4 (23.5) ASP; moderate in 2 (8.7%) CDT and 1 (5.9%) ASP, severe in 9(39.1%) CDT and 6 (35.3%) ASP. Occlusion was noted in 2 (8.7%) CDT and 6 (35%) ASP. Recanalization resulted in final patency of 22 (95%) CDT and 15 (88%) ASP.

CONCLUSION

ASP and CDT may both be employed for clearing thrombus in PSS, however, they differ on early efficacy, PTC, and patency. While often more rapid and convenient, our results suggest ASP may be inferior to CAT in management of PSS.