Ep. 50 Managing Pulmonary Embolism: Guidelines and 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. \--- Get the BackTable app https://www.backtable.com/app \--- This podcast is supported by Penumbra https://www.penumbrainc.com/ \--- Timestamps 00:00 - Introduction 03:57 - PERT Structure and Activation 08:24 - PE Risk Stratification Tools 12:02 - Patient Selection for IR Intervention 15:21 - Assessing Clot Chronicity 21:03 - Standardizing Workup 26:38 - Managing Unstable PE 28:31 - STORM-PE and HI-PEITHO Trial Data 35:49 - Guidelines vs. New Evidence 40:12 - Determining Therapeutic Endpoints 45:05 - Upcoming Trials and Future Directions 51:46 - Final Thoughts and Closing Remarks \--- 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. \--- Resources 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults https://doi.org/10.1161/CIR.0000000000001415 Composite Pulmonary Embolism Shock (CPES) Score https://doi.org/10.1161/CIRCINTERVENTIONS.124.014088 FOCUS study https://doi.org/10.1093/eurheartj/ehac206 STORM-PE trial https://doi.org/10.1161/CIRCULATIONAHA.125.077232 HI-PEITHO trial https://doi.org/10.1056/nejmoa2516567 PE-TRACT study https://petractstudy.org/homepage PEERLESS II study https://clinicaltrials.gov/study/NCT06055920 PERSEVERE trial https://clinicaltrials.gov/study/NCT06588634 \--- BackTable Cardiology is the go-to podcast for interventional cardiologists, cardiac surgeons, and other healthcare professionals that manage cardiovascular conditions. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app