Key result
FlowTriever thrombectomy with temporary PFO occlusion successfully manages right atrial thrombus despite high bleeding risk.
Why the study?
Cardiac masses require tailored management, and right atrial thrombi in patients with a patent foramen ovale pose dual risks of pulmonary and paradoxical embolism, complicating treatment when anticoagulation is contraindicated.
Case Report (n=1)
Mechanical thrombectomy combined with temporary PFO occlusion and cerebral protection is a feasible strategy for managing right atrial thrombus in patients with a PFO and contraindications to anticoagulation.
May support percutaneous thrombectomy for right atrial thrombus when anticoagulation is contraindicated; leaves open need for prospective evaluation.
Background: Cardiac masses include thrombi, vegetations, and tumours, each requiring tailored treatment. Right atrial thrombi, often linked to venous thromboembolism, risk pulmonary embolism, while left-sided thrombi pose systemic embolization risks. Management ranges from anticoagulation to surgical or percutaneous intervention based on stability and embolization risks. Case summary: A 57-year-old man presented with multi-trauma and intracranial bleeding. Transthoracic echocardiography revealed a thrombus in the right atrium, alongside a large patent foramen ovale (PFO) with atrial septal aneurysm. The thrombus posed a dual embolic risk: pulmonary embolism or paradoxical embolism via the PFO. Due to contraindications for anticoagulation, an urgent procedure was performed with FlowTriever® to extract the thrombus. A cerebral protection device was deployed to safeguard the supra-aortic trunks, and a sizing balloon was inflated to temporarily occlude the PFO. Discussion: We report a case of multidisciplinary management of a right atrial thrombus in a trauma patient at high bleeding risk in the presence of a PFO. Mechanical thrombectomy and temporary PFO occlusion can be utilized to prevent embolism, while PFO closure could be deferred to avoid bleeding complications in a high bleeding context.
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Sanfilippo et al. (2025) conducted a case report in Right atrial thrombus and patent foramen ovale in a multi-trauma patient (n=1). Mechanical thrombectomy with FlowTriever® and temporary PFO occlusion was evaluated on Thrombus extraction and embolism prevention. Mechanical thrombectomy using FlowTriever and temporary PFO occlusion successfully managed a right atrial thrombus in a trauma patient with high bleeding risk and a patent foramen ovale.
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