Mechanical thrombectomy for pulmonary embolism in patients with patent foramen Ovale

Nariman Nezami,Arun Chockalingam,Jeffrey Pollak,Joshua Cornman-Homonoff,Angelo Marino,Hamid Mojibian

doi:10.1186/s42155-020-00180-9

Abstract

BackgroundThe current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited.ResultsThis was a retrospective analysis of 9 patients with PFO and acute high-risk or intermediate-high-risk PE, 6 with intermediate-high risk and 3 with high-risk PE. All underwent MT using the Inari FlowTriever System from Dec 2018 to November 2019. Six of these patients had confirmed deep venous thrombosis. The technical and clinical success rate for MT in all patients was 100% and 77.8%, respectively. Right-heart strain improved in 6/8 patients on follow-up echocardiography. Mean main pulmonary artery (MPA) pressure significantly decreased after MT (p < 0.012). One patient presented with altered mental status (somnolence and disorientation) prior to coronary artery angiogram and thrombectomy, developed a middle cerebral artery embolic stroke 1 day after MT, and recovered with minor sequalae and later was discharged. There was no in-hospital mortality.ConclusionsMT using FlowTriever was feasible and safe, successfully improving MPA pressure in patients presenting with concurrent PFO and PE.

Highlights

The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited
Patent foramen ovale (PFO) in patients with acute pulmonary embolism (PE) can represent a poor prognostic indicator related to risk of paradoxical embolic stroke, which is more common in PE patients with PFO (21.4%) due to increased right ventricle (RV) and atrial pressure resulting in a right-to-left interatrial shunt in the acute phase of PE (Le Moigne et al, 2019)
While there are multiple case reports on application of catheter based interventions in patients with concurrent PE and PFO, there is no report of MT devices as alternative options in this population (Chockalingam et al, 2020)

Summary

Introduction

The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited. Patent foramen ovale (PFO) in patients with acute pulmonary embolism (PE) can represent a poor prognostic indicator related to risk of paradoxical embolic stroke, which is more common in PE patients with PFO (21.4%) due to increased right ventricle (RV) and atrial pressure resulting in a right-to-left interatrial shunt in the acute phase of PE (Le Moigne et al, 2019). While there are multiple case reports on application of catheter based interventions in patients with concurrent PE and PFO, there is no report of MT devices as alternative options in this population (Chockalingam et al, 2020).

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