Key result
Modified flower technique enables intact percutaneous retrieval of brittle intracardiac cement emboli.
Case Report
A modified flower technique using a lengthwise-slit inner sheath allows a brittle intracardiac cement embolus to be covered and withdrawn percutaneously intact without breaking.
May enable percutaneous extraction of cardiac cement emboli; leaves open prospective validation before routine adoption.
To show how a brittle cement embolus in the heart can be removed percutaneously after vertebral augmentation. Place a large outer sheath in the internal jugular vein. Cut the tip of an inner sheath lengthwise in 3 places. Snare the embolus. Pull it back so that the strips open outward and cover it. Withdraw the inner sheath and embolus together as one smooth piece. Cement is brittle, and the usual failure is breakage rather than loss of grip. Keep the force low and size the outer sheath to the loaded assembly. Strong traction to align the embolus with the sheath can break it. Ensure cardiac surgical backup and monitor for pericardial effusion. A slit inner sheath opens outward around the snared embolus, so the brittle cement can be withdrawn intact.
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Hanabusa et al. (2026) conducted a case report in Intracardiac cement embolus after vertebral augmentation. Percutaneous retrieval using a modified flower technique with a 3-slit inner sheath was evaluated on Intact percutaneous removal of the brittle intracardiac cement embolus. A modified flower technique using a 3-slit inner sheath via the internal jugular vein allows intact percutaneous withdrawal of a brittle intracardiac cement embolus.
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