Percutaneous Thrombectomy of Clot in Transit Lodged in the Patent Foramen Ovale Using the FlowTriever Device: Case Report

TL;DR

A rare case of a blood clot lodged in the heart was successfully removed using a new device, avoiding surgery or risky clot-dissolving drugs.

Contribution

Presents a novel percutaneous thrombectomy approach for managing impending paradoxical embolism using the FlowTriever device.

Findings

Aspiration thrombectomy with the FlowTriever device successfully removed the clot in transit.

Cerebral protection using the SENTINEL device was employed to prevent embolic stroke during the procedure.

The approach offers a less invasive alternative to surgery or thrombolysis for this life-threatening condition.

Abstract

A clot in transit is a venous thrombus lodged in the right heart en route to the pulmonary arteries. When a clot in transit lodges in a patent foramen ovale, it becomes an impending paradoxical embolism (IPDE), a rare, life-threatening condition with a 30-day mortality of 18.4%. Management options—surgical extraction, anticoagulation, or thrombolysis—lack consensus. We present the case of a 53-year-old man with a saddle pulmonary embolism, in whom postthrombectomy transthoracic echocardiogram revealed an IPDE. This case illustrates aspiration thrombectomy of the IPDE with the FlowTriever device (Inari Medical) with cerebral protection (SENTINEL, Boston Scientific), offering an alternative to thrombolysis and surgery.

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