Catheter-Directed Thrombolysis for Giant Right Atrial Thrombus

Abstract

Giant right atrial thrombus in association with a medical device is rare1,2 but when present poses the threat of massive pulmonary embolism. Surgical resection, catheter embolectomy, and thrombolysis are the principal options for management. We present the case of a 60-year-old man with bilateral pulmonary embolism and a 6-cm right atrial thrombus adherent to an implantable cardioverter-defibrillator (ICD) wire. We treated him successfully with a prolonged intravenous infusion of catheter-directed, low-dose tissue plasminogen activator therapy. Two weeks before admission, he had an acute myocardial infarction and had severely occlusive atherosclerotic coronary disease on coronary angiography. However, a culprit thrombotic lesion to account for the acute myocardial infarction could not be identified. Four days later, the patient survived an in-hospital ventricular fibrillation-induced cardiac arrest, after which an ICD was placed. He was discharged on aspirin …