# Cerebral-Protected Percutaneous Thrombectomy for Near-Occlusive LVAD Outflow Graft Thrombosis

## TL;DR

A 70-year-old man with a HeartMate 3 LVAD experienced a life-threatening outflow graft blockage, successfully treated with a minimally invasive procedure that restored normal device function.

## Contribution

This case highlights a successful, minimally invasive treatment for LVAD outflow graft thrombosis using cerebral-protected thrombectomy.

## Key findings

- Computed tomographic angiography revealed >90% thrombotic narrowing of the distal outflow graft.
- Percutaneous cerebral-protected thrombectomy restored complete graft patency and device flow to 4 L/min.
- Early imaging-guided intervention can safely treat outflow graft thrombosis and avoid emergent pump exchange.

## Abstract

Late low-flow alarms in left ventricular assist devices (LVADs) most commonly result from volume depletion or right-sided failure, but mechanical outflow graft obstruction is an infrequent yet life-threatening cause.

A 70-year-old man with a HeartMate 3 LVAD presented with persistent low-flow (0 L/min) alarms after defecation but felt entirely well. Laboratory testing showed no overt hemolysis, and transthoracic echocardiography excluded right-sided failure. Computed tomographic angiography revealed >90% thrombotic narrowing of the distal outflow graft. The patient underwent percutaneous cerebral-protected thrombectomy with a Penumbra aspiration catheter followed by serial balloon dilatations (8-18 mm) achieving complete graft patency and immediate restoration of device flow to 4 L/min.

Outflow graft thrombosis occurs in approximately 2% to 5% of contemporary LVAD recipients and carries high morbidity if untreated. Few reports describe successful catheter-directed thrombectomy; this case highlights prompt multimodality imaging, a heart-team approach, and the utility of cerebral protection to mitigate embolic risk.

Persistent low-flow alarms mandate systematic evaluation. Early imaging-guided intervention can safely rescue outflow graft thrombosis and avoid emergent pump exchange.