{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:24:52Z","timestamp":1782894292931,"version":"3.54.5"},"reference-count":50,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Vasc Med"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Saddle pulmonary embolism (SPE) is defined as large emboli located at the bifurcation of the main pulmonary artery. The prevalence and optimal intervention for SPE remain unclear. Herein, we focus on contemporary epidemiology and reperfusion strategies for SPE with acute cor pulmonale (SPE-ACP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The National Inpatient Sample of the USA (2016\u20132022) was analyzed. Diagnoses and procedures were identified by International Classification of Diseases, Tenth Revision (ICD-10) codes. Therapies were classified as conventional therapy (CT), systemic fibrinolysis (SF), catheter-directed thrombolysis (CDTL), and catheter-directed mechanical thrombectomy (CDMT). Outcomes evaluated were bleeding, transfusion, discharge to home, and in-hospital mortality. Statistical analyses included chi-squared tests, Wilcoxon rank-sum tests, propensity score matching, and logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      SPE-ACP constituted 1.7% of all PEs (frequency-trend, 2016\u20132022,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      <jats:sub>trend<\/jats:sub>\n                      &lt; 0.001); 49.2% of patients received CT. Among advanced reperfusion therapies (ARTs), SF was associated with higher risks of major bleeding and mortality (vs CDTL\/CDMT,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). CDTL was associated with lower transfusion risk (vs SF\/CDMT,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01) and higher rates of discharge to home (vs SF,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.009). Notably, CDMT showed increasing trends in utilization and discharge to home, and decreasing trends in transfusion and mortality (2016\u20132022, all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      <jats:sub>trend<\/jats:sub>\n                      &lt; 0.05). Except for transfusion (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.013), the outcomes became comparable between CDTL and CDMT (2020\u20132022, all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &gt; 0.10). SPE-ACP with acute popliteal\/femoral deep vein thrombosis (DVT) was associated with lower mortality risk (vs no femoropopliteal DVT, all\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>SPE-ACP, an uncommon condition, showed a substantially increased prevalence over time. Among ARTs, favorable outcomes were observed with CDTL during 2016\u20132022; CDMT may be evolving into an alternative strategy given its relatively comparable outcomes during 2020 to 2022. SPE-ACP with concomitant acute femoral\/popliteal DVT may be associated with lower mortality risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1358863x261431264","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T12:17:51Z","timestamp":1781093871000},"page":"310-322","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Saddle pulmonary embolism with acute cor pulmonale in contemporary practice: Epidemiological trends and reperfusion strategies"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0948-806X","authenticated-orcid":false,"given":"Wenzhu","family":"Li","sequence":"first","affiliation":[{"name":"Unaffiliated, Butte, MT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7516-4873","authenticated-orcid":false,"given":"Stavros K","family":"Kakkos","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University of Patras School of Medicine, Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9211-5483","authenticated-orcid":false,"given":"Ahmed A","family":"Tawakol","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy L","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Translational Cardiovascular Research Center, University of Arizona College of Medicine, Phoenix, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-4927","authenticated-orcid":false,"given":"Peter K","family":"Henke","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Vascular Surgery, Conrad Jobst Vascular Laboratories, University of Michigan Health System, Ann Arbor, MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3861-3163","authenticated-orcid":false,"given":"Eric A","family":"Secemsky","sequence":"additional","affiliation":[{"name":"Richard and Susan Smith Center for Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2392-7365","authenticated-orcid":false,"given":"Rachel P","family":"Rosovsky","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology &amp; Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2022.07.013"},{"key":"e_1_3_2_3_2","article-title":"Saddle pulmonary embolism: Demographics, clinical presentation, and outcomes","volume":"3","author":"Wong KJ","year":"2021","unstructured":"Wong KJ, Kushnir M, Billett HH. 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