Ep. 671 Managing Pulmonary Embolism: Guidelines & Clinical Decisions with Dr. Timothy Fernandes and Dr. Robert Lookstein

Once your PERT is assembled, how do you navigate the evolving pulmonary embolism (PE) literature to improve patient outcomes at all risk levels? In this episode of the BackTable Podcast, interventional radiologist Dr. Robert Lookstein (Mount Sinai) and pulmonary critical care specialist Dr. Timothy Fernandes (UC San Diego) join host Dr. Harris Chengazi to examine the latest evidence and multidisciplinary strategies for managing acute pulmonary embolism. The discussion highlights the complexities of catheter-directed therapies in intermediate- to high-risk PE, evolving guidelines in the face of new trial data, and prioritization of improving patients’ clinical trajectories.

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This podcast is supported by

Penumbra

https://www.penumbrainc.com/

Timestamps

00:00 - Introduction03:57 - PERT Structure and Activation08:24 - PE Risk Stratification Tools12:02 - Patient Selection for IR Intervention15:21 - Assessing Clot Chronicity21:03 - Standardizing Workup26:38 - Managing Unstable PE28:31 - STORM-PE and HI-PEITHO Trial Data35:49 - Guidelines vs. New Evidence40:12 - Determining Therapeutic Endpoints45:05 - Upcoming Trials and Future Directions51:46 - Final Thoughts and Closing Remarks

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More about this episode

The physicians explore the nuances of validated PE risk stratification tools, assessing the relationship between various PE scoring systems and the 2026 ACC/AHA classification for acute PE. They emphasize that the integration of clinical assessment, serial lab work, and patient history must take precedence over static imaging alone in guiding care. The doctors go on to review new trial data, including the improved RV-to-LV ratio and 90-day functional gains seen with mechanical thrombectomy in STORM-PE and reduced clinical deterioration observed with ultrasound-assisted catheter-directed thrombolysis in HI-PEITHO. The conversation concludes with a call for collaborative, safety-first management that focuses on the patient’s clinical status and long-term post-PE functional recovery.