EVT Panel Discussion: Expert Perspectives on the Modern PE Landscape

The landscape of pulmonary embolism (PE) care is evolving with better diagnosis and risk-stratification, team-based decision making, and advanced treatment technologies. The recently published STORM-PE randomized controlled trial (RCT) adds Level 1 evidence to the movement toward advanced endovascular therapies as a frontline option for patients with acute intermediate-high risk PE.

Against this backdrop, three national leaders in PE care came together for a forward-looking panel discussion, sponsored by Penumbra and published in Endovascular Today.

Expert Perspectives: The Modern PE Landscape and Evolving Care with STORM-PE

Featuring:

• Dr. Timothy Fernandes, MD, MPH, Director of Comprehensive Pulmonary Embolism Care and Professor of Medicine at UC San Diego Health
• Dr. Robert Lookstein, MD, MHCDL Professor of Radiology and Surgery and Executive Vice Chairman of the Department of Diagnostic, Molecular, and Interventional Radiology at the Icahn School of Medicine at Mount Sinai
• Dr. Rachel Rosovsky, MD, MPH, Department of Medicine at Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School

Below is a summary of their insights.

STORM-PE: A Foundational Trial for PE Intervention

The panelists collectively cited the STORM-PE RCT as a pivotal moment for the field. “STORM-PE is foundational,” said Dr. Lookstein. “PE patients randomized to Penumbra’s Computer Assisted Vacuum Thrombectomy (CAVT™) plus AC achieved a markedly greater reduction in RV/LV ratio than those on AC alone, with significantly more achieving a > 0.2 reduction and normalization to ≤ 1.0 at 48 hours with a comparable safety profile.”¹
Early right heart recovery also aligned with improved clinical measures, such as:

• lower heart rate
• reduced oxygen requirement
• significantly greater 90-day functional capacity found in 6-minute walk assessment¹

“What distinguishes STORM-PE from prior studies is its deliberate focus on recovery beyond early physiologic improvement,” said Dr. Rosovsky. “Patient-centered functional outcomes were incorporated, including post-VTE functional scale and their predicted walking capacity (which adjusts for sex, age, and body surface area). Patients treated with CAVT achieved a substantially higher percentage of their predicted walking capacity at 90 days (94% vs 75%), reflecting more complete functional recovery.”

Procedural Considerations and Patient Selection

Efficiency is of the utmost importance when it comes to PE. “The longer you keep a symptomatic patient on the table, the more opportunity there is for trouble,” said Dr. Lookstein. “The Lightning Flash^® (CAVT) device lets us move decisively, and now we have high-quality evidence that it’s not just fast — it’s better for patients.”

On top of being fast, the data shows that CAVT is as safe as anticoagulation alone.ⁱ STORM-PE “reported 100% technical success, with no device- or procedure-related transfusions, no access site complications, and no device-related mortality,” said Dr. Rosovsky.

Modern Diagnosis and Evolving Risk Stratification

Discussing diagnosis, the panelists acknowledged that PE remains clinically elusive, yet diagnostic workflows have sharpened substantially. “In 2026, we’re diagnosing PE faster and with greater precision. A modern workup pairs high-quality CT pulmonary angiography with a deliberate look at right ventricular (RV) function,” said Dr. Lookstein. “RV/LV is a critical indicator of right heart recovery or failure; it’s the physiologic readout of right heart strain and is tightly linked to early adverse outcomes.”

A key to improving diagnosis and care is refinements in classifying PE severity. “I think we’re moving beyond the classic bins,” said Dr. Lookstein. “The 2019 European Society of Cardiology (ESC) framework that split ‘intermediate’ into intermediate-low and intermediate-high has served us well, but the conversation now includes a ‘catastrophic’ subgroup within high risk (patients in cardiac arrest or peri-arrest) because they behave differently and demand different escalation strategies.”

Dr. Fernandes underscored the need to consider both acute and long-term consequences:

“Short-term prognosis is important, but we also need to think about long-term prognosis and risk stratify patients to consider both “will they survive the next 48 hours with PE?” and also “will they be functional at 6 months?’”

Infrastructure and the Expanding Role of PERTs

The panel agreed that multidisciplinary PE Response Teams (PERTs) have transformed hospital care. “Multiple studies have demonstrated that PERT implementation is associated with improvements in care delivery, including shorter time to diagnosis, decreased time to therapeutic AC, lower rates of inferior vena cava filters, and reduced ICU utilization,” said Dr. Rosovsky.

There’s no one right PERT model, but successful ones do have similar strategies. “Successful PERTs are built on rapid multidisciplinary collaboration, clear activation pathways, timely access to advanced diagnostics and therapies, and structured post-discharge follow-up care, while remaining aligned with evolving guidelines, emerging therapies, and the latest research,” said Dr. Rosovsky.

Guidelines: A Turning Point Ahead?

The panel discussed how the STORM-PE data may influence guidelines, which have changed little for decades, despite innovation and adoption. “ESVM’s [The European Society of Vascular Medicine] recent update is an early sign of what’s to come,” said Dr. Lookstein. “The 2025 guideline on interventional treatment for VTE formalized indications and emphasized procedures within experienced centers, signaling a broader acceptance of catheter-based strategies when patient selection is sound.”

But the panel notes that not all catheter-directed therapies offer the same benefits. “I would not say that you can take any catheter off the shelf because results from STORM-PE were positive,” said Dr. Fernandes. “I would say that these data support CAVT and it would end there. Hopefully that’s what the guidelines also endorse.”

Looking Ahead

The panel sees the future of PE care as bright. “I think we are at a true inflection point in PE care — opening the door to more personalized treatment, improved recovery, and a broader, patient-focused approach to improving both short- and long-term outcomes,” said Dr. Rosovsky.

Dr. Lookstein had three predictions for the future of PE care. “Risk stratification will get sharper — with formal recognition of a more complex and comprehensive classification spectrum,” said Dr. Lookstein. He also expects broader recognition and adoption of early mechanical thrombectomy. “We now know that subsequent gains in functional capacity at 90 days are only realized with early interventional treatment such as CAVT,” said Dr. Lookstein. And finally, the guidelines will start to catch up to these changes.

The EVT feature also includes an overview of CAVT technology and PE cases from Clay Wiske, MD, a vascular surgeon at Stanford Health in Pleasanton, California and Adam Reichard, MD, a vascular surgeon at TriHealth Heart and Vascular Institute in Cincinnati.

Read the full EVT article.

Important Safety Information

Additional information about Penumbra’s products can be located on Penumbra’s website at https://www.penumbrainc.com/products/peripheral-thrombectomy-cavt/. The clinical results presented herein are for informational purposes only and may not be predictive for all patients. Individual results may vary depending on patient-specific attributes and other factors. Caution: Federal (USA) law restricts these devices to sale by or on the order of a physician. Prior to use, please refer to Instructions for Use (IFU) for complete product indications, contraindications, warnings, precautions, potential adverse events, and detailed instructions for use. For the complete Penumbra IFU Summary Statements, visit: peninc.info/risk. Please contact your local Penumbra representative for more information.

Copyright ©2026 Penumbra, Inc. All rights reserved. CAVT and Lightning Flash are registered trademarks or trademarks of Penumbra, Inc. in the USA and other countries.

^{1. Lookstein RA, Konstantinides SV, Weinberg I, et al. Randomized controlled trial of mechanical thrombectomy with anticoagulation versus anticoagulation alone for acute intermediate-high risk pulmonary embolism: primary outcomes from the STORM-PE trial. Circulation. 2026;153:21-34. doi: 10.1161/CIRCULATIONAHA.125.077232
i. STORM-PE was powered for the primary endpoint only; additional analysis demonstrated significantly greater benefit for the CAVT arm across multiple parameters.}