Mechanical Thrombectomy for High-Risk Pulmonary Embolism in Pregnancy: A Case Report and a Systematic Review of the Literature.

Pulmonary embolism (PE) in pregnancy is a major clinical challenge with potentially fatal maternal and fetal outcomes. Mechanical thrombectomy (MT) offers a promising alternative when thrombolysis is contraindicated, although evidence in pregnancy is limited. We describe a 26-year-old at 29 + 5 weeks' gestation with high-risk PE causing acute right heart failure, successfully treated, achieving rapid hemodynamic recovery, and minimal fetal radiation exposure. A systematic review identified 15 MT cases in pregnancy or peripartum (11 antepartum, 4 postpartum), reporting 100% maternal survival and favorable fetal outcomes in 87% (1 fetal death, 1 abortion). Complications occurred in 40%, including hemolysis, renal failure, and hemorrhagic shock. MT appears to be an effective, potentially life-saving option in selected obstetric patients when performed in experienced centers with multidisciplinary support.Clinical ImpactMechanical thrombectomy (MT) represents a valuable therapeutic option for high-risk pulmonary embolism in pregnancy when thrombolysis is contraindicated. In this setting, MT allows for rapid reperfusion and hemodynamic stabilization while avoiding the bleeding risks associated with systemic fibrinolysis. Early consideration of MT within a multidisciplinary framework might significantly improve maternal prognosis without compromising fetal safety.