Extracting a Malpositioned Occluder Device Using Endovascular Forceps

Transcatheter left atrial appendage occlusion (LAAO) is a low-risk procedure with a <1.0% risk of malposition. An 80-year-old man with atrial fibrillation intolerant to apixaban underwent implantation of a 24 mm Watchman FLX device (Boston Scientific), which immediately shifted, exposing uncovered metal in the left atrium. Four weeks later, an AngioVac F22180 catheter (AngioDynamics) was advanced into the left atrium and a 10-mm Raptor grasping forceps (Steris) was introduced via the AngioVac catheter. Using the Raptor, the Watchman FLX was grasped and with cautious, sustained force extracted into the AngioVac (Video 1) and out of the body intact (Figure 1). A 28 mm Amulet device (Abbott) was then implanted. While alternative approaches to LAAO device retrieval have been described, this is to our knowledge the first report describing the use of an AngioVac catheter to extract a malpositioned Watchman FLX (Video 2) and achieving successful LAAO by replacement with an Amulet. Implanting proceduralists must be equipped to salvage high-risk complications such as device malposition.