RSS-Feed abonnieren
PDF herunterladen
DOI: 10.1055/s-0041-1730117
Prevention of Paradoxical Cerebral Embolus with Protection System during Combination Right Atrial Clot Aspiration Thrombectomy and Closure of Patent Foramen Ovale
Abstract
In this technical case report, we describe a 41-year-old female with a history of breast cancer who was found to have a right atrial clot attached to the tip of her Port-A-Cath. During transthoracic echocardiography to evaluate her clot, she was also noted to also have a patent foramen ovale. The decision was made to perform a simultaneous right atrial endovascular aspiration thrombectomy and patent foramen ovale closure. To minimize the risk for paradoxical embolus during clot manipulation, an intravascular embolic neuroprotection device was deployed. After the procedure, it was noted on visual inspection that the device filter contained several embolic fragments. The presence of macroscopic embolic fragments in the filter baskets highlights the role of prophylactic embolic protection when performing cardiac interventions in the setting of a patent foramen ovale, particularly in the presence of a right atrial thrombus or mass.
Publikationsverlauf
Artikel online veröffentlicht:
04. Juni 2021
© 2021. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
-
References
- 1 Smith CR, Leon MB, Mack MJ. et al. PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364 (23) 2187-2198
- 2 Wendt D, Kleinbongard P, Knipp S. et al. Intraaortic protection from embolization in patients undergoing transaortic transcatheter aortic valve implantation. Ann Thorac Surg 2015; 100 (02) 686-691
- 3 Lok CE, Huber TS, Lee T. et al. National Kidney Foundation. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 2020; 75 (04) S1-S164
- 4 Chick JFB, Reddy SN, Bhatt RD, Shin BJ, Kirkpatrick JN, Trerotola SO. Significance of echocardiographically detected central venous catheter tip-associated thrombi. J Vasc Interv Radiol 2016; 27 (12) 1872-1877
- 5 Yang H, Chen F, Jiao H. et al. Management of tunneled-cuffed catheter-related right atrial thrombosis in hemodialysis patients. J Vasc Surg 2018; 68 (05) 1491-1498
- 6 Kapadia SR, Kodali S, Makkar R. et al. SENTINEL Trial Investigators. Protection against cerebral embolism during transcatheter aortic valve replacement. J Am Coll Cardiol 2017; 69 (04) 367-377
- 7 Giustino G, Sorrentino S, Mehran R, Faggioni M, Dangas G. Cerebral embolic protection during TAVR: a clinical event meta-analysis. J Am Coll Cardiol 2017; 69 (04) 465-466
- 8 Eggebrecht H, Schmermund A, Mehta RH. TAVR and stroke prevention: importance of cerebral embolic protection device data. J Am Coll Cardiol 2017; 70 (10) 1306-1307
- 9 Seeger J, Gonska B, Otto M, Rottbauer W, Wöhrle J. Cerebral embolic protection during transcatheter aortic valve replacement significantly reduces death and stroke compared with unprotected procedures. JACC Cardiovasc Interv 2017; 10 (22) 2297-2303