What question did this study set out to answer?

The aim is to evaluate the effectiveness of mechanical thrombectomy for treating clot-in-transit in a patient with pulmonary embolism.

March 21, 2026Open Access

Multimodality Diagnostics and Endovascular Large-Bore Aspiration Thrombectomy of the Clot-in-Transit

Key Result

Endovascular mechanical thrombectomy is an effective therapeutic option for high-risk pulmonary embolism patients with a clot-in-transit and contraindications to systemic thrombolysis.

Key Points

The aim is to evaluate the effectiveness of mechanical thrombectomy for treating clot-in-transit in a patient with pulmonary embolism.
Case report of a 70-year-old woman with massive pulmonary embolism and clot-in-transit.
Point-of-care ultrasonography used to diagnose large mobile thrombus in the right atrium.
Mechanical thrombectomy performed due to haemodynamic instability and contraindication for systemic thrombolysis.
Successful aspiration of a large thrombus from the right heart and pulmonary arteries.
Patient stabilized and recovered right ventricular function after thrombectomy.
Discharged on oral anticoagulation with complete recovery at follow-up.

Structured PICO

Population

70-year-old woman with massive bilateral pulmonary embolism complicated by a clot-in-transit, haemodynamic instability, and a contraindication for systemic thrombolysis

Intervention

Endovascular large-bore aspiration thrombectomy (mechanical thrombectomy)

Outcome

Haemodynamic stabilization and recovery of right ventricular function

Mechanical thrombectomy is a viable and effective treatment for patients with massive pulmonary embolism and clot-in-transit who have contraindications to systemic thrombolysis.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Clot-in-transit (CIT) is a free-floating thrombus in the right heart and can enter pulmonary circulation at any moment. Possible treatments include anticoagulation, systemic thrombolysis, surgical embolectomy, and endovascular catheter-based therapies. The optimal treatment is still undetermined, heavily relying on clinical judgment and multidisciplinary team discussion. We report a case of a 70-year-old woman presenting with tachydyspnoea following recent abdominal surgery, who was diagnosed with massive bilateral pulmonary embolism (PE) complicated by a clot-in-transit. Point-of-care ultrasonography revealed a large mobile thrombus in the right atrium with severe right ventricular dysfunction. Due to haemodynamic instability and a contraindication for systemic thrombolysis, mechanical thrombectomy was performed. A large thrombotic burden was aspirated from the right heart and pulmonary arteries, resulting in haemodynamic stabilization and recovery of right ventricular function. The patient remained stable throughout hospitalization and was discharged on oral anticoagulation therapy with complete recovery on follow-up. This case highlights several points. Firstly, CIT is a rare finding but should be considered in patients with massive pulmonary embolism and shock. Furthermore, POCUS is essential for diagnosing CIT. Finally, mechanical thrombectomy is a valuable therapeutic option in high-risk PE patients with contraindications to systemic thrombolysis and haemodynamic instability. Further studies are needed to establish adequate guidelines for the optimal management of CIT patients.