Key result
Right atrial aspiration thrombectomy clears a 15-cm clot-in-transit, immediately restoring hemodynamics in acute PE.
Case Report (n=1)
Selective right atrial aspiration thrombectomy can rapidly restore hemodynamic stability in patients with acute pulmonary embolism complicated by clot-in-transit and obstructive shock, even in very elderly patients with contraindications to thrombolysis.
May offer a rescue option for obstructive shock in thrombolysis-contraindicated clot-in-transit; leaves open generalizability and need for prospective trials.
IMAGE(S): Computed tomography and transthoracic echocardiography demonstrating right atrial (RA) clot-in-transit (CIT) causing dynamic tricuspid inflow obstruction in acute pulmonary embolism. CASE SUMMARY: A 96-year-old woman presented with recurrent syncope, hypoxia, and shock requiring vasopressor support. Imaging demonstrated acute pulmonary embolism with right ventricular dilation/dysfunction and a mobile RA CIT intermittently prolapsing across the tricuspid valve. Systemic thrombolysis was contraindicated because of recent ischemic stroke. Selective RA aspiration thrombectomy removed a 15-cm thrombus, resulting in immediate hemodynamic improvement. TAKE-HOME MESSAGES: Dynamic tricuspid inflow obstruction may contribute to shock in CIT complicating acute pulmonary embolism. Selective intracardiac thrombectomy may rapidly restore hemodynamic stability.
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Shavgulidze et al. (2026) conducted a case report in Acute pulmonary embolism with right atrial clot-in-transit and shock (n=1). Selective right atrial aspiration thrombectomy was evaluated on Hemodynamic improvement and clot removal. Selective right atrial aspiration thrombectomy successfully removed a 15-cm thrombus and resulted in immediate hemodynamic improvement in a patient with acute pulmonary embolism and clot-in-transit.
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