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Case Reports
. 2022 Nov 6;4(24):101667.
doi: 10.1016/j.jaccas.2022.09.029. eCollection 2022 Dec 21.

The "Lollipop" During Catheter-Directed Thrombectomy: 2 Case Examples

Daniella Concha  1 , Sanjum S Sethi  1 , Navneet Sharma  1 , Koji Takeda  1 , Anthony Pucillo  1 , Martin B Leon  1 , Erika Berman-Rosenzweig  1 , Ajay J Kirtane  1 , Sahil A Parikh  1 , Matthew T Finn  1
Affiliations
Case Reports

The "Lollipop" During Catheter-Directed Thrombectomy: 2 Case Examples

Daniella Concha et al. JACC Case Rep. .

Abstract

Intraprocedural embolization has been described as a potential complication of catheter thrombectomy for acute pulmonary embolism and may be under-recognized. We describe 2 case examples of "Lollipopping" during thrombectomy, which may be a mechanism of intraprocedural embolization and describe our treatment approach. (Level of Difficulty: Advanced.).

Keywords: IVC, inferior vena cava; PE, pulmonary embolism; RHC, right heart catheterization; complication; pulmonary circulation; thrombus.

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Conflict of interest statement

Dr Sethi has received honoraria from Janssen and Chiesi Inc. Dr Leon has served as a nonpaid advisory board member and receives institutional clinical research grants from Abbott, Boston Scientific, Medtronic, and Sinomed. Dr Kirtane has received institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Amgen, CSI, Philips, ReCor Medical, Neurotronic, Biotronik, Chiesi, Bolt Medical, Magenta Medical, Canon, SoniVie, and Merck (institutional funding includes both research grants and fees paid to Columbia University and/or Cardiovascular Research Foundation for consulting and/or speaking engagements in which Dr Kirtane controlled the content); has served as a consultant for IMDS; and has received travel expenses/meals from Medtronic, Boston Scientific, Abbott Vascular, CSI, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Dr Parikh has received institutional grants/research support from Abbott Vascular, Shockwave Medical, TriReme Medical, Sumodics, Silk Road Medical, and the National Institutes of Health; has received consulting fees from Terumo and Abiomed; and has served on the Advisory Boards of Abbott, Medtronic, Boston Scientific, CSI, Janssen, and Philips. Dr Finn has received speaker fees from Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Images for Case 1 (A and B) Contrast computed tomography demonstrating large obstructive clot primarily in the right main pulmonary artery with significant right ventricular enlargement. (C,Video 1) Pulmonary angiogram with near total obstruction of the right pulmonary artery. (D,Video 2) Lollipopped clot on the end of the T24 in the inferior vena cava. Note, a larger Dryseal sheath (26-F) was used to allow for injection around the T24 to demonstrate the clot. (E,Video 3) The T24 with the lollipopped clot on the end and the dryseal were retracted to the iliac vein. Using a new 14-F access in the left femoral vein, the XL discs were placed to act as proximal embolic protection. (F,Video 4) Venogram of the XL discs after removal of the lollipopped clot from the right venous access site. (G,Video 5) Repeat pulmonary artery angiogram with significant improvement in right-sided perfusion. (H,Video 6) Angiogram of the left pulmonary artery with embolized clot. (I) Clot extracted during the procedure.
Figure 2
Figure 2
Schematic of Lollipop Clot and Technique for Removal (A) Schematic of the lollipopped clot on the distal tip of the T24 FlowTriever in the right external iliac vein. (B) Schematic of the Inari XL discs placed via the left femoral vein into the cava utilized as proximal embolic protection. Figure created with BioRender.com with publication and licensing rights.
Figure 3
Figure 3
Images for Case 2 (A) Left pulmonary angiogram with pulmonary embolism in the left lower lobe arterial branches. (B) Thrombus on the end of the T24 after retraction to the right iliac vein. (C) Placement of the Inari XL discs from left groin access in a similar manner to Case 1. (D) Thrombus in the right venous access site removed with forceps. (E) Clot haul from Case 2. (F) Competition left pulmonary angiogram with improved flow into the left lung.
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References

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