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Case Reports
. 2023 Jun 16;28(2):83-85.
doi: 10.1016/j.jccase.2023.04.005. eCollection 2023 Aug.

Endovascular approach to a complex thrombus in-transit through a patent foramen ovale

Lorenzo A D'Angelo  1 , Yingyot Arora  2 , Miguel A Diaz  1 , Roger G Carrillo  1 , Cosmin Guta  1 , Marquand Patton  1
Affiliations
Case Reports

Endovascular approach to a complex thrombus in-transit through a patent foramen ovale

Lorenzo A D'Angelo et al. J Cardiol Cases. .

Abstract

Large atrial thrombi can be managed percutaneously. We present a case of a 76-year-old female patient who presented to our emergency room with an acute stroke and was managed with mechanical thrombectomy. Further work-up revealed a large complex thrombus in-transit trapped in a patent foramen ovale with a large mobile portion in the left atrium. Due to contraindications for thrombolysis and poor surgical candidacy, an endovascular approach was favored. The procedure was performed successfully, and the patient recovered uneventfully.

Learning objective: Endovascular approach with mechanical thrombectomy can be a treatment option for patients that present with large thrombus in-transit when other therapies are contraindicated.

Keywords: Atrial septal defect; Left atrium; Patent foramen ovale; Right atrium; Thrombectomy; Thrombus.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Transesophageal echocardiogram (TEE) showing 2D and 3D images of trapped complex thrombus in-transit. (A) Thrombus extending from the right atrium to the left atrium (LA). (B) Thrombus through the interatrial septum. (C) LA portion of the thrombus crossing the mitral valve and extending to the left ventricle (D) 3D TEE showing LA portion of the thrombus.
Fig. 2
Fig. 2
Transesophageal echocardiogram showing 2D image of intra-procedure AngioVac™ system aspirating the thrombus in-transit. (A) AngioVac™ system. (B) Thrombus in-transit.
Fig. 3
Fig. 3
Gross examination of thrombus aspirated from the right and left atrium; 22-cm cast-shaped thrombus removed from the right and left atrium.
See this image and copyright information in PMC

References

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