Learning ObjectivesTo describe the initial experience of an IR practice with the FlowTriever thrombectomy device for acute pulmonary thromboembolism with description of the technical feasibility, safety profile, and clinical outcomes.BackgroundPatients with acute PE who have clinical, ECG, echocardiographic, or chest CT evidence of right ventricular dysfunction are classified as having massive or submassive PE, depending on any associated hypotension. Fibrinolytic therapy is life-saving as it may avert impending hemodynamic collapse and death due to progressive RV failure, however may be relatively or absolutely contraindicated. In patients who require aggressive therapy, but in whom thrombolysis is contraindicated, catheter-assisted embolectomy has emerged as a technique for advanced therapy, including thrombus fragmentation, thrombus capture or aspiration. Mechanical devices that capture clot and allow bulk extraction have proven effective in other vascular beds, such as in stroke management. We report our experience with the recently FDA-approved FlowTriever System (Inari Medical) for non-surgical removal of thromboemboli from the pulmonary arterial vasculature in two patients.Clinical Findings/Procedure DetailsTwo patients with acute submassive PE, with inability to be heparinized or fibrinolysed due to recent surgery, underwent percutaneous mechanical thrombectomy with the FlowTriever system. In both cases, the device was successfully delivered to the second order branches of the pulmonary circulation. No acute complications were encountered, and in both cases thrombus was aspirated. In both cases, additional thrombectomy devices were used to complete target clot removal however.ConclusionsThis new thromboectomy system appears to be technically feasible and safe for percutaneous removal of pulmonary thromboemboli, and of particular value in patients who may be considered unsuitable for anticoagulation or fibrinolysis. Although potentially a promising tool in the armamentarium of the interventional radiologist, studies with larger patient populations are necessary to claim safety and efficacy.