SIR 2024
Venous Interventions
Emily Barnard, MD
Radiology Resident
UC San Diego
Financial relationships: Full list of relationships is listed on the CME information page.
Jose F. Saucedo, MD
Resident
University of California San Diego
Financial relationships: Full list of relationships is listed on the CME information page.
Jonas Redmond, MD
Associate Professor of Clinical Radiology
UCSD
Financial relationships: Full list of relationships is listed on the CME information page.
Interventions involving the right heart in patients with intracardiac thrombus or valvular vegetation present a clinical challenge. While aspiration thrombectomy can be successfully performed for pulmonary embolism (PE) under conventional fluoroscopy, the visual assessment of mobile intracardiac thrombus remains problematic. Consequently, interventionalists rely on anatomical approximations and pre-procedural CT imaging, lacking real-time visual information. This study explores the advantages of utilizing intraprocedural ultrasound (IPUS), specifically intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE), for real-time visualization in right heart interventions.
Clinical Findings/Procedure Details:
This exhibit will explore 4 cases of right heart aspiration thrombectomy, employing the Inari FlowTriever in conjunction with ICE or TEE. These cases encompass interventions performed at the right atrium, tricuspid valve, right ventricle, and pulmonic valve. Angiography failed to visualize aspiration thrombectomy targets in 3 of 4 cases. Excellent visualization of intracardiac thrombus, valvular lesions, and thrombectomy catheter was achieved in all cases by IPUS. Complete removal of thrombus or vegetation was confirmed by follow-up CT or echocardiogram. During the discussion, we will describe the techniques and ultrasound windows used to achieve precise thrombus localization, optimal catheter placement, and determine successful and complete removal of both intracardiac and valvular targets.
Conclusion and/or Teaching Points:
IPUS can be used as an adjunctive imaging modality for aspiration thrombectomy when treating intracardiac thrombus and valvular vegetations. By employing real-time visualization within the cardiac chambers, IPUS not only enhances procedural accuracy but also ensures a reliable endpoint for intervention. The representative cases emphasize the versatility and adaptability of this innovative technique, highlighting its impact on patient care, procedural efficacy, and clinical outcomes in the context of complex right heart interventions.