PMC6888743_01
(A) Right atrial and ventricular clot burden shown by transthoracic echocardiogram. The transthoracic echocardiogram shows large mobile thrombi in the right atrium and ventricle (B) The left lung pulmonary emboli. Preliminary angiography showed thrombus within the left lower lobe segmental artery and lack of perfusion distally.
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Bedside transthoracic echocardiography in the intensive care unit (ICU) revealed a large mobile thrombus in the right atrium and clot burden in the proximal main pulmonary artery (PA) (Fig. 1A), as well as right ventricle (RV) strain. Subsequent digital subtraction imaging in the right anterior oblique projection confirmed thrombus within the left lower lobe PA (Fig. 1B).
The FlowTriever system (A) The FlowTriever system consists of a 20 Fr, 95 cm catheter, called the Triever20 catheter, which is placed through the right heart into the pulmonary artery. The Triever20 catheter can be used by itself to perform suction thrombectomy or can be used as a guide through which the FlowTriever catheter is advanced (B) The FlowTriever catheter has a trio of self expanding nitinol mesh disks near the tip of the catheter that are unsheathed to engage for mechanical clot capture and retrieval through the Triever20, disrupt, and extract the thrombus while simultaneously aspirating and withdrawing this through the Triever20 catheter.
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Triever20 catheter (Fig. 2A) used for direct clot aspiration via a 60 mL self locking syringe and a FlowTriever catheter which was not used in this case (Fig. 2B). The Triever20 catheter was advanced into the right atrium under fluoroscopy and subsequently real time transthoracic echocardiography guidance.
(A) The Triever20 catheter, part of the FlowTriever system was advanced into the right atrium and seen to directly engage thrombus under transthoracic echocardiogram guidance (B) The clot was trapped at the tip of the Triever20 catheter and carefully retrieved into the sheath (C) Picture of the thrombus removed from the right atrium (D) The right atrial and ventricular thrombi were successfully removed, resulting in a substantially reduced right heart thrombus burden with minimal residual thrombus probably adherent to the tricuspid valve.
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A large thrombus was captured (Fig. 3A) and aspirated out of the right atrium with the Triever20 catheter alone under real time transthoracic echocardiography guidance (Fig. 3B and C) with some residual clot noted (Fig. 3D).
Pulmonary artery thrombectomy (A) The right panel shows the Triever20 catheter advanced into the left lower lobe segmental artery, suction applied, and thrombi extracted from the left pulmonary artery (B) The middle panel shows the Inari device and retrieved clots (C) The left panel shows restored patency of the left lower lobe segmental artery after suction thrombectomy.
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Next, the Triever20 catheter was advanced to the left PA (Fig. 4A). A large amount of clot was retrieved from the left lower lobe segmental PA using the Triever20 catheter (Fig. 4B), with no residual pulmonary clot visible on angiography after two thrombectomy passes (Fig. 4C).