Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec 20;39(5):515-522.
doi: 10.1055/s-0042-1757942. eCollection 2022 Oct.

Right Heart Clot-in-Transit: Endovascular Therapies

Sipan Mathevosian  1 , Mona Ranade  1
Affiliations
Review

Right Heart Clot-in-Transit: Endovascular Therapies

Sipan Mathevosian et al. Semin Intervent Radiol. .

Abstract

Right heart thrombus is a challenging high mortality disease typically seen in the setting of pulmonary embolism. Traditional treatments have included anticoagulation, thrombolysis, and surgical embolectomy. Advances in recognition and treatment of clot-in-transit have led to the development of endovascular therapies increasingly becoming the preferred method of treatment due to rapid debulking and lower morbidity. Novel endovascular devices are large bore aspiration thrombectomy systems which mitigate the use of concomitant thrombolytics. The article reviews the disease process, relevant literature, and current endovascular devices and strategies for the treatment of right heart thrombus and clot-in-transit.

Keywords: aspiration thrombectomy; pulmonary embolism; right heart thrombus.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest M.R. serves as the national PI for AngioDynamics Inc. APEX – AV trial assessing AlphaVac Multipurpose Mechanical Aspiration (MMA) F18 PE System in the treatment of pulmonary embolism.

Figures

Fig. 1
Fig. 1
( a ) Transesophageal echocardiogram (TEE) demonstrating mobile right atrial thrombus (arrow); ( b ) intraoperative images of the AngioVac aspiration cannula (dashed arrow) advanced under continuous fluoroscopic and TEE guidance (solid arrow) for treatment of atrial lead associated thrombus (arrowhead); ( c ) aspiration filter with large-volume thrombus after thrombectomy with venovenous extracorporeal membrane oxygenation cannula in the background; ( d ) diagram courtesy of Angiodynamics demonstrating the procedure components and setup.
Fig. 2
Fig. 2
( a ) CTA demonstrating large burden of pulmonary embolus; ( b ) transesophageal echocardiogram demonstrating concurrent right atrial thrombus; ( c ) aspiration thrombectomy of right heart thrombus with FlowTriever T24; ( d ) posttreatment right atrial clot burden is shown.
Fig. 3
Fig. 3
( a ) Intraoperative image of the AlphaVac thrombectomy cannula advanced to the cavoatrial junction; ( b ) pulmonary angiography demonstrating large-volume right pulmonary artery embolism; ( c ) transesophageal echocardiogram demonstrating mobile right atrial thrombus; ( d ) posttreatment right atrial clot burden is shown.
See this image and copyright information in PMC

References

    1. RIETE Investigators . Barrios D, Rosa-Salazar V, Jiménez D. Right heart thrombi in pulmonary embolism. Eur Respir J. 2016;48(05):1377–1385. - PubMed
    1. Goldhaber S Z, Visani L, De Rosa M.Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) Lancet 1999353(9162):1386–1389. - PubMed
    1. Muramoto H, Niwa A, Satoh Y. Clinical significance and prognosis of right heart thrombi associated with acute pulmonary thromboembolism - results of a multicenter registry of thrombolysis in Japan. Circ J. 2021;85(04):353–360. - PubMed
    1. Barkhausen J, Hunold P, Eggebrecht H. Detection and characterization of intracardiac thrombi on MR imaging. AJR Am J Roentgenol. 2002;179(06):1539–1544. - PubMed
    1. Leibowitz G, Keller N M, Daniel W G. Transesophageal versus transthoracic echocardiography in the evaluation of right atrial tumors. Am Heart J. 1995;130(06):1224–1227. - PubMed