Key result
AngioVac thrombectomy with cerebral protection successfully resolves biatrial thrombus without stroke.
Why the study?
Experience with transcatheter vacuum-assisted mass extraction for left-sided intracardiac thrombus is limited, especially in high-risk patients with thrombus in transit through a patent foramen ovale.
Does percutaneous vacuum-assisted thrombectomy with cerebral protection provide a safe alternative to open surgical thrombectomy for an inoperable patient with a biatrial thrombus traversing a patent foramen ovale?
Case Report (n=1)
No
Does percutaneous vacuum-assisted thrombectomy with cerebral protection provide a safe alternative to open surgical thrombectomy for an inoperable patient with a biatrial thrombus traversing a patent foramen ovale?
Percutaneous vacuum-assisted thrombectomy with cerebral protection and temporary flow arrest provides a feasible and safe alternative to surgery for high-risk patients with biatrial thrombi in transit across a patent foramen ovale.
BACKGROUND: Transcatheter vacuum-assisted mass extraction is a safe alternative to surgical thrombectomy in high-risk patients, although experience with left-sided intracardiac material is limited. CASE PRESENTATION: A 19-year-old man with newly diagnosed Hodgkin lymphoma developed airway compromise, cardiac tamponade, massive pulmonary embolism, and cardiogenic shock requiring venoarterial-venous extracorporeal membrane oxygenation. Echocardiography showed a mobile biatrial thrombus traversing a patent foramen ovale. Because of prohibitive surgical risk, he underwent AngioVac (AngioDynamics, Inc) thrombectomy with bilateral cerebral embolic protection, transient aortic flow arrest, and septal occluder-mediated thrombus entrapment, with hemodynamic stabilization and no stroke on follow-up imaging. DISCUSSION: In a patient with biatrial thrombus and prohibitive surgical risk, percutaneous AngioVac thrombectomy provided a feasible alternative to open thrombectomy. Cerebral protection, transient interruption of antegrade aortic flow during left atrial aspiration, and septal occluder-mediated thrombus containment addressed the major risk of systemic embolization. TAKE-HOME MESSAGES: Biatrial thrombus traversing a patent foramen ovale requires treatment planning that accounts for both pulmonary and systemic embolic risk. In selected inoperable patients, cerebral protection, temporary aortic flow arrest, vacuum-assisted aspiration, and septal occluder-mediated thrombus entrapment can be considered within a multidisciplinary strategy.
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Nallapati et al. (2026) conducted a case report in Biatrial thrombus traversing a patent foramen ovale (n=1). Percutaneous AngioVac thrombectomy was evaluated on Hemodynamic stabilization and stroke occurrence. Percutaneous AngioVac thrombectomy with cerebral protection successfully treated a 19-year-old man with a biatrial thrombus, achieving hemodynamic stabilization and no stroke on follow-up.
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