The PEERLESS II Study

NCT ID: NCT06055920

Last Updated: 2026-01-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-17

Study Completion Date

2026-07-31

Brief Summary

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This study is a prospective, multicenter, randomized controlled trial of the FlowTriever System plus anticoagulation compared to anticoagulation alone for intermediate-risk acute PE.

Detailed Description

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Conditions

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Pulmonary Embolism

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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FlowTriever

Mechanical thrombectomy for pulmonary embolism using the FlowTriever System.

Group Type ACTIVE_COMPARATOR

FlowTriever System

Intervention Type DEVICE

Mechanical Thrombectomy for pulmonary embolism

Anticoagulation

Commercially available/market approved anticoagulation medication including but not limited to: Heparin Sodium, Coumadin, Rivaroxaban, Apixaban, etc.

Anticoagulants are a group of medications that decrease your blood's ability to clot.

Group Type ACTIVE_COMPARATOR

Anticoagulation Agents

Intervention Type DRUG

Commercially available/market approved anticoagulation medication including but not limited to: Heparin Sodium, Coumadin, Rivaroxaban, Apixaban, etc.

Anticoagulants are a group of medications that decrease your blood's ability to clot.

Interventions

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FlowTriever System

Mechanical Thrombectomy for pulmonary embolism

Intervention Type DEVICE

Anticoagulation Agents

Commercially available/market approved anticoagulation medication including but not limited to: Heparin Sodium, Coumadin, Rivaroxaban, Apixaban, etc.

Anticoagulants are a group of medications that decrease your blood's ability to clot.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Age at enrollment ≥ 18 years
2. Objective evidence of a proximal filling defect in at least one main or lobar pulmonary artery, as confirmed by CTPA, pulmonary angiography, or other imaging modality
3. RV dysfunction, as defined as one or more of the following: RV/LV ratio ≥ 0.9 or RV dilation or hypokinesis
4. At least two additional risk factors, identified by at least one measure in two separate categories noted below:

a. Hemodynamic: i. SBP 90-100mmHg ii. Resting heart rate \> 100 bpm b. Biomarker: i. Elevated\* cardiac troponin (troponin I or troponin T, conventional or high sensitivity) ii. Elevated\* BNP or NT-proBNP iii. Elevated venous lactate ≥2 mmol/L \* Elevated, meaning at or above the upper limit of normal, per local standards for the assay used c. Respiratory: i. O2 saturation \< 90% on room air ii. Supplemental O2 requirement ≥ 4 L/min iii. Respiratory rate ≥ 20 breaths/min iv. mMRC score \> 0
5. Symptom onset within 14 days of confirmed PE diagnosis
6. Willing and able to provide informed consent

Exclusion Criteria

1. Unable to be anticoagulated with heparin, enoxaparin or other parenteral antithrombin
2. Presentation with hemodynamic instability\* that meets the high-risk PE definition in the 2019 ESC Guidelines1, including ANY of the following

1. Cardiac arrest OR
2. Systolic BP \< 90 mmHg or vasopressors required to achieve a BP ≥ 90 mmHg despite adequate filling status, AND end-organ hypoperfusion OR
3. Systolic BP \< 90 mmHg or systolic BP drop ≥ 40 mmHg, lasting longer than 15 min and not caused by new-onset arrhythmia, hypovolemia, or sepsis \* Patients who are stable at time of screening or randomization (i.e., SBP ≥ 90 mmHg and adequate organ perfusion without catecholamine or vasopressor infusion) may be included despite initial presentation including temporary, low-dose catecholamines or vasopressors, or temporary fluid resuscitation.
3. Known sensitivity to radiographic contrast agents that, in the Investigator's opinion, cannot be adequately pre-treated
4. Imaging evidence or other evidence that suggests, in the opinion of the Investigator, the patient is not appropriate for catheter-based intervention (e.g., inability to navigate to target location, clot limited to segmental/subsegmental distribution, predominately chronic clot)
5. End stage medical condition with life expectancy \< 3 months, as determined by the Investigator
6. Current participation in another drug or device study that, in the investigator's opinion, would interfere with participation in this study
7. Current or history of chronic thromboembolic pulmonary hypertension (CTEPH) or chronic thromboembolic disease (CTED) diagnosis, per 2019 ESC Guidelines1
8. If objective testing was performed\*, estimated RV systolic pressure \> 70 mmHg on standard of care echocardiography \* If clinical suspicion of acute-on-chronic PE, chronic obstruction, or chronic thromboembolism, echocardiographic estimated RVSP must be confirmed ≤70 mmHg to meet eligibility. Pressure assessment not required if Investigator attests to absence of such clinical suspicion
9. Administration of advanced therapies (thrombolytic bolus, thrombolytic drip/infusion, catheter-directed thrombolytic therapy, mechanical thrombectomy, or ECMO) for the index PE event within 30 days prior to enrollment
10. Ventricular arrhythmias refractory to treatment at the time of enrollment
11. Known to have heparin-induced thrombocytopenia (HIT)
12. Subject has any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subject (e.g., compromise the well-being or that could prevent, limit, or confound the protocol-specified assessments). This includes a contraindication to use of FlowTriever System per local approved labeling
13. Subject is currently pregnant
14. Subject has previously completed or withdrawn from this study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Inari Medical

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Frances Mae West, MD

Role: PRINCIPAL_INVESTIGATOR

Jefferson Health

Jay Giri, MD

Role: PRINCIPAL_INVESTIGATOR

Penn Medicine

Bernhard Gebauer, MD

Role: PRINCIPAL_INVESTIGATOR

Charité University Hospital Berlin

Felix Mahfoud, MD

Role: PRINCIPAL_INVESTIGATOR

Universitaetsspital Basel

Locations

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UAB Division of Cardiovascular Disease

Birmingham, Alabama, United States

Site Status RECRUITING

Brookwood Medical Center

Birmingham, Alabama, United States

Site Status COMPLETED

Huntington Memorial Hospital

Pasadena, California, United States

Site Status RECRUITING

University of Colorado, Denver

Aurora, Colorado, United States

Site Status RECRUITING

Yale University

New Haven, Connecticut, United States

Site Status RECRUITING

HCA FL Largo Medical Center

Largo, Florida, United States

Site Status RECRUITING

AdventHealth Orlando

Orlando, Florida, United States

Site Status RECRUITING

Emory University

Atlanta, Georgia, United States

Site Status RECRUITING

Northwestern University

Chicago, Illinois, United States

Site Status RECRUITING

Baptist Health Louisville

Louisville, Kentucky, United States

Site Status WITHDRAWN

McLaren Greater Lansing

Lansing, Michigan, United States

Site Status RECRUITING

Metropolitan Heart & Vascular Institute

Coon Rapids, Minnesota, United States

Site Status WITHDRAWN

Mayo Clinic

Rochester, Minnesota, United States

Site Status WITHDRAWN

Saint Luke's Hospital of Kansas City

Kansas City, Missouri, United States

Site Status RECRUITING

Mercy Hospital Springfield

Springfield, Missouri, United States

Site Status RECRUITING

Nebraska Medical Center

Omaha, Nebraska, United States

Site Status RECRUITING

Virtua Health

Camden, New Jersey, United States

Site Status RECRUITING

Valley Health

Ridgewood, New Jersey, United States

Site Status WITHDRAWN

SUNY, The University of Buffalo/Gates Vascular

Buffalo, New York, United States

Site Status RECRUITING

Northwell Health

New York, New York, United States

Site Status RECRUITING

Jamaica Hospital

Queens, New York, United States

Site Status RECRUITING

University of Rochester Medical Center

Rochester, New York, United States

Site Status RECRUITING

Stony Brook University Hospital

Stony Brook, New York, United States

Site Status RECRUITING

Montefiore Medical Center

The Bronx, New York, United States

Site Status RECRUITING

University of Cincinnati Medical Center

Cincinnati, Ohio, United States

Site Status RECRUITING

The Cleveland Clinic Foundation

Cleveland, Ohio, United States

Site Status RECRUITING

Ohio State University - Wexner Medical Center

Columbus, Ohio, United States

Site Status RECRUITING

St. Luke's University Hospital

Bethlehem, Pennsylvania, United States

Site Status RECRUITING

AHN Saint Vincent Hospital

Erie, Pennsylvania, United States

Site Status RECRUITING

UPMC Hamot

Erie, Pennsylvania, United States

Site Status RECRUITING

UPMC Harrisburg

Harrisburg, Pennsylvania, United States

Site Status RECRUITING

The University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Allegheny Health Network Research Institute

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

UPMC Heart and Vascular Institute

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Wellspan York Hospital

York, Pennsylvania, United States

Site Status RECRUITING

HCA Tristar

Brentwood, Tennessee, United States

Site Status RECRUITING

UTMC Knoxville

Knoxville, Tennessee, United States

Site Status RECRUITING

Ascension Saint Thomas Hospital

Nashville, Tennessee, United States

Site Status RECRUITING

Parkland Hospital

Dallas, Texas, United States

Site Status RECRUITING

Texas Health Harris Methodist Hospital

Fort Worth, Texas, United States

Site Status RECRUITING

Methodist Main Hospital

San Antonio, Texas, United States

Site Status RECRUITING

Baylor Scott & White - Temple

Temple, Texas, United States

Site Status RECRUITING

Inova Fairfax

Falls Church, Virginia, United States

Site Status RECRUITING

Sentara Vascular Specialists

Norfolk, Virginia, United States

Site Status NOT_YET_RECRUITING

University of Washington

Seattle, Washington, United States

Site Status RECRUITING

Providence Sacred Heart

Spokane, Washington, United States

Site Status WITHDRAWN

Charleston Area Medical Center

Charleston, West Virginia, United States

Site Status RECRUITING

West Virginia University Ruby Memorial Hospital

Morgantown, West Virginia, United States

Site Status RECRUITING

Aurora Saint Luke's Medical Center

Milwaukee, Wisconsin, United States

Site Status RECRUITING

Onze Lieve Vrouwziekenhuis

Aalst, , Belgium

Site Status RECRUITING

Royal Columbian Hospital

New Westminster, British Columbia, Canada

Site Status RECRUITING

Surrey Memorial Hospital

Surrey, British Columbia, Canada

Site Status RECRUITING

Vancouver General Hospital

Vancouver, British Columbia, Canada

Site Status RECRUITING

Aarhus University Hospital

Aarhus, , Denmark

Site Status RECRUITING

CHU Lille

Lille, , France

Site Status RECRUITING

Hôpital Louis Pradel

Lyon, , France

Site Status RECRUITING

AP-HM Hopital La Timone

Marseille, , France

Site Status RECRUITING

Hôpital Nord Marseille

Marseille, , France

Site Status RECRUITING

University Hospital Augsburg

Augsburg, , Germany

Site Status RECRUITING

Universitäts-Herzzentrum Bad Krozingen

Bad Krozingen, , Germany

Site Status RECRUITING

Charité Campus Virchow Clinic - Klinik fuer Radiologie

Berlin, , Germany

Site Status RECRUITING

Unfall Krankenhaus Berlin

Berlin, , Germany

Site Status RECRUITING

University Hospital Cologne

Cologne, , Germany

Site Status RECRUITING

HerzZentrum Dresden Universitaetsklinik

Dresden, , Germany

Site Status RECRUITING

Universitaetsklinikum Dὒsseldorf

Düsseldorf, , Germany

Site Status RECRUITING

Elisabeth Hospital GmbH

Essen, , Germany

Site Status RECRUITING

Universitaetsklinikum Essen

Essen, , Germany

Site Status RECRUITING

CCB Frankfurt

Frankfurt, , Germany

Site Status RECRUITING

Universitaetsklinikum Hamburg Eppendorf

Hamburg, , Germany

Site Status RECRUITING

University Hospital - Heidelberg

Heidelberg, , Germany

Site Status RECRUITING

Universitaetsklinikum Saarlandes Homburg

Homburg, , Germany

Site Status WITHDRAWN

Westpfalz Klinikum

Kaiserslautern, , Germany

Site Status RECRUITING

Klinikum rechts der Isar (TUM)

Munich, , Germany

Site Status RECRUITING

Ludwig Maximilians-University

Munich, , Germany

Site Status RECRUITING

University Hospital Regensburg

Regensburg, , Germany

Site Status RECRUITING

Helios Kliniken Schwerin

Schwerin, , Germany

Site Status RECRUITING

Schwarzwald-Baar-Klinikum

Villingen-Schwenningen, , Germany

Site Status RECRUITING

John Paul II Hospital

Krakow, , Poland

Site Status NOT_YET_RECRUITING

Hopital Clinico Universitario San Carlos

Madrid, , Spain

Site Status RECRUITING

Universitaetsspital Basel

Basel, , Switzerland

Site Status RECRUITING

Universitätsspital Bern

Bern, , Switzerland

Site Status RECRUITING

Luzerner Kantonsspital

Lucerne, , Switzerland

Site Status RECRUITING

Countries

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United States Belgium Canada Denmark France Germany Poland Spain Switzerland

Central Contacts

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Stephanie Gourley

Role: CONTACT

580-400-2590

Facility Contacts

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Samuel McElwee, MD

Role: primary

Nikhil Daga, MD

Role: primary

Peter Hountras, MD

Role: primary

Akhil Khosla, MD

Role: primary

Jesse J Klein, DO

Role: primary

Barry Weinstock, MD

Role: primary

Wissam Jaber, MD

Role: primary

Daniel Schimmel, MD

Role: primary

Ibrahim Shah, MD

Role: primary

Jennifer Buckley, MD

Role: primary

Madhu Kalyan Pendurthi, MD

Role: primary

Jason Cook, MD

Role: primary

Rita Butler, MD

Role: primary

David Zlotnick, MD

Role: primary

Bushra Mina, MD

Role: primary

Zoran Lasic, MD

Role: primary

Jeffrey Bruckel, MD

Role: primary

Daniel Ohngemach, MD

Role: primary

Asma Khaliq, MD

Role: primary

Rishi Sukhija, MD

Role: primary

Aravinda Nanjundappa, MD

Role: primary

Richard Gumina, MD

Role: primary

Neal Fitzpatrick, MD

Role: primary

Orestis Pappas, MD

Role: primary

Robert Maholic, DO

Role: primary

Torrey Schmidt, DO

Role: primary

Sameer Khandhar, MD

Role: primary

Mae West, MD

Role: primary

Mithun Chakravarthy

Role: primary

Catalin Toma, MD

Role: primary

Paul Tolerico, MD

Role: primary

Sam Horr, MD

Role: primary

Chris Walker, MD

Role: primary

Jimmy Kerrigan, MD

Role: primary

Akram Sadeghi, MD

Role: primary

John Hollingsworth, MD

Role: primary

Chandra Kunavarapu, MD

Role: primary

Jeffrey DellaVolpe, MD

Role: backup

Tasnim Lat, DO

Role: primary

Jonathan Keung, MD

Role: primary

David Dexter, MD

Role: primary

Matthew Abad-Santos, MD

Role: primary

Shadi Abu-Halimah, MD

Role: primary

Sunil Sharma, MD

Role: primary

Khawaja Afzal Ammar, MD

Role: primary

Marc Vanderheyden, MD

Role: primary

Zameer Hirji, MD

Role: primary

Behrang Homayoon

Role: primary

Gordon Finlayson, MD

Role: primary

Asger Andersen, MD, PhD

Role: primary

Gilles Lemesle, Prof. Dr. med.

Role: primary

Salim Si-Mohamed, Prof. Dr. med.

Role: primary

Thomas Cuisset, MD

Role: primary

Marc Laine, Dr. med.

Role: primary

Christian Scheurig-Mὒnkler, Dr.

Role: primary

Elias Noory, Dr. med.

Role: primary

Bernhard Gebauer, Prof. Dr. med.

Role: primary

Rainer Wasielewski, Dr. med.

Role: primary

Stephan Rosenkranz, Prof.

Role: primary

Norman Mangner, Prof. Dr. med.

Role: primary

Hans Lucas Busch, Dr. med.

Role: primary

Moaaz Elsharabassy, Dr.

Role: primary

Christos Rammos, Prof. Dr. med.

Role: primary

Michael Piorkowski, Dr. med.

Role: primary

Fabian Brunner, Prof Dr. Med

Role: primary

Richard Schell, Dr.

Role: primary

Burghard Schumacher, Prof.

Role: primary

Tareq Ibrahim, Prof. Dr.

Role: primary

Konstantin Stark, Prof.

Role: primary

Stefan Stadler, Prof. Dr. med.

Role: primary

Philipp Hammer, Dr. med.

Role: primary

Sebastian Ewen, Prof Dr. Med

Role: primary

Grzegorz Kopeć, Prof. Med.

Role: primary

Pablo Salinas, Dr. med.

Role: primary

Gregor Leibundgut, Dr. med.

Role: primary

Stefan Stortecky, Prof. Dr. med

Role: primary

Thorsten Grumann, Dr. med.

Role: primary

References

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Giri J, Mahfoud F, Gebauer B, Andersen A, Friedman O, Gandhi RT, Jaber WA, Pereira K, West FM. PEERLESS II: A Randomized Controlled Trial of Large-Bore Thrombectomy Versus Anticoagulation in Intermediate-Risk Pulmonary Embolism. J Soc Cardiovasc Angiogr Interv. 2024 May 3;3(6):101982. doi: 10.1016/j.jscai.2024.101982. eCollection 2024 Jun.

Reference Type BACKGROUND
PMID: 39132600 (View on PubMed)

Other Identifiers

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23-001

Identifier Type: -

Identifier Source: org_study_id

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