PMC9280839_01
(a) Axial and (b) coronal CTA demonstrating extensive bilateral PE extending into main pulmonary arteries, segmental and subsegmental pulmonary arteries. Also demonstrated is reflux of contrast into IVC and hepatic veins secondary to elevated right heart pressure.
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Computed tomography angiography (CTA) of the chest showed extensive clot burden bilaterally in all five lobes with evidence of increased right ventricle (RV) to left ventricle (LV) ratio and reflux of contrast into the inferior vena cava (IVC) and hepatic veins, concerning for RV strain (Figure 1).
(a) Right pulmonary angiogram before CDE demonstrating large clot in the right interlobar pulmonary artery (arrows) with extension into middle lobe and lower lobe segmental branches. (b) Right pulmonary angiogram demonstrating markedly improved perfusion to the right middle and lower lobes after CDE.
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Right pulmonary angiogram demonstrated nearly occlusive thrombus within the interlobar pulmonary artery and basal segmental branches of the lower lobe (Figure 2). The Triever24 aspiration catheter was used to remove a large volume of clot with three suctions (Figure 2).