What does this research mean for the field?

Percutaneous debulking using the AngioVac system under intracardiac echocardiography guidance safely and successfully removes ascending aortic mural thrombi, overcoming visualization blind spots of transesophageal echocardiography. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe a minimally invasive percutaneous approach to debulk a high-risk mobile ascending aortic mural thrombus using intracardiac echocardiography guidance to overcome transesophageal echocardiography blind spots.

July 18, 2026JACC Case ReportsOpen Access

Percutaneous Aspiration of Ascending Aortic Mural Thrombus Under Intra-Aortic Intracardiac Echocardiographic Guidance

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Ascending aortic mural thrombus (n=1). Intervention: Percutaneous aspiration using AngioVac system with ICE guidance. Primary outcome: Successful thrombus removal and procedural safety.

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Key result

AngioVac with ICE guidance successfully debulks ascending aortic mural thrombus without complications.

Why the study?

Ascending aortic mural thrombus can be highly mobile and cause systemic embolization even without aneurysm or advanced atherosclerosis, with TEE having blind spots in the proximal ascending aorta.

Key Points

To describe a minimally invasive percutaneous approach to debulk a high-risk mobile ascending aortic mural thrombus using intracardiac echocardiography guidance to overcome transesophageal echocardiography blind spots.
Treated a 57-year-old man presenting with a 26 × 11 mm ascending aortic mural thrombus who developed internal carotid artery occlusion despite systemic heparin anticoagulation.
Introduced an 18-F AngioVac cannula via femoral arterial access and an intracardiac echocardiography probe via an 8-F left brachial artery sheath to localize the thrombus and direct real-time aspiration.
Configured blood return via a 17-F cannula in the right common femoral vein under conscious sedation.
Intra-aortic intracardiac echocardiography enabled real-time visualization and guidance, allowing aspiration flow rates ramped to 4 to 5 L/min to safely debulk the mobile mass without embolic or vascular complications.
Follow-up computed tomography angiography at 48 hours postprocedure confirmed removal of the mobile component with residual adherent broad-based thrombus and no penetrating aortic ulcer.
Pathology confirmed the aspirated specimen was thrombus, and the patient remained hemodynamically stable without new neurological deficits.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A 57-year-old man with ascending aortic mural thrombus and high surgical risk who underwent successful percutaneous aspiration using the AngioVac system under ICE guidance.

Intervention

Percutaneous debulking using the AngioVac system (F18 cannula) with intracardiac echocardiography (ICE) guidance via a brachial approach.

Outcome

Successful removal of the thrombus without complications.

Percutaneous aspiration using the AngioVac system under ICE guidance is a feasible and safe alternative for removing mobile ascending aortic mural thrombi in high-surgical-risk patients.

Limitations

Single case report

Implication

May offer a percutaneous option for high-surgical-risk patients with ascending aortic thrombi; leaves open need for prospective validation.

Abstract

BACKGROUND: Ascending aortic mural thrombus can be highly mobile and cause systemic embolization, even without aneurysm or advanced atherosclerosis. CASE SUMMARY: A 57-year-old man with coronary artery disease, prior coronary artery bypass grafting, chronic obstructive pulmonary disease, and recent orthopedic surgery presented with chest tightness and cough. Computed tomography angiography revealed a multilobulated ascending aortic mural thrombus measuring 26 × 11 mm. Despite heparin therapy, he developed acute right internal carotid artery occlusion requiring thrombectomy. Follow-up imaging showed persistent mobile thrombi, and transesophageal echocardiography (TEE) was limited. Percutaneous debulking using the AngioVac system with intracardiac echocardiography (ICE) guidance successfully removed the thrombus without complications. DISCUSSION: This case demonstrates a novel percutaneous approach for ascending aortic thrombus removal using intra-aortic ICE to overcome TEE blind spots, allowing safe, targeted aspirations. TAKE-HOME MESSAGE: TEE has blind spots in the proximal ascending aorta. ICE provides real-time guidance, facilitating safer real-time procedural visualization and AngioVac thrombus aspirations.

Discussion

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Published by JACC Case Reports · CC BY-NC-ND

Cite This Study

Al-Sahli et al. (2026) conducted a case report in Ascending aortic mural thrombus (n=1). Percutaneous aspiration using AngioVac system with ICE guidance was evaluated on Successful thrombus removal and procedural safety. Percutaneous debulking using the AngioVac system with intracardiac echocardiography guidance successfully removed an ascending aortic mural thrombus without complications.

synapsesocial.com/papers/6a5b38f68167787360d24dc4 https://doi.org/10.1016/j.jaccas.2026.108868

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Implication

May offer a percutaneous option for high-surgical-risk patients with ascending aortic thrombi; leaves open need for prospective validation.

Percutaneous Aspiration of Ascending Aortic Mural Thrombus Under Intra-Aortic Intracardiac Echocardiographic Guidance

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Percutaneous Aspiration of Ascending Aortic Mural Thrombus Under Intra-Aortic Intracardiac Echocardiographic Guidance

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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