Advanced Percutaneous Thrombectomy Techniques for Large Right Atrial Thrombus Using Continuous Suction

To understand the application and benefits of a dual-device approach for the percutaneous thrombectomy of complex right atrial thrombi.

Background:

Right atrial thrombi present significant clinical challenges with their association with higher mortality due to cardiac dysfunction and potential embolization to pulmonary arteries. Standard therapies include anticoagulation, systemic and catheter-based thrombolysis, and open surgical embolectomy. For patients with large thrombi and contraindications to thrombolysis, open embolectomy remains the standard approach, despite its high bleeding risk and mortality rates.

While percutaneous thrombectomy has emerged as a less invasive alternative, it is often limited based on thrombus size and localization. This exhibit will describe the simultaneous use of the AngioVac and AlphaVac devices for successful mechanical suction thrombectomy of large right atri­­al thrombi. This combined approach enables continuous aspiration to reduce embolization risk, highlighting advancements in percutaneous thrombectomy techniques for complex cases.

Clinical Findings/Procedure Details: This exhibit will discuss:
- Simultaneous usage of the AngioVac and AlphaVac systems.
- Synergistic effects of combining continuous and strong mechanical manual aspiration techniques.
- Combining percutaneous techniques to capture large or adherent right atrial thrombus from above and below to avoid more invasive surgical interventions.
- Maintenance of constant negative pressure with extracorporeal bypass and filtered blood return to limit thrombus fragmentation and distal embolization.
- Integration of Intracardiac Echocardiography (ICE) for real-time visualization in patients with contraindications to Transesophageal Echocardiography (TEE).
- Application of Intravascular Ultrasound (IVUS) to assess residual clot burden and location and confirm complete removal of large thrombi under suction that may remain in the sheath .
- Piecemeal extraction of thrombus fragments using multiple passes and constant manual suction.

Conclusion and/or Teaching Points:

This educational exhibit will highlight advanced techniques to expand treatment options for patients with large or adherent right atrial thrombi, particularly those at high surgical risk or with contraindications or resistance to thrombolysis.  As interventional techniques advance, the synergistic use of multiple devices may reduce the need for invasive surgical interventions and improve patient outcomes.