Acute-on-chronic massive pulmonary embolism treated with 3-loop snare

A 70-year-old man presented with acute massive pulmonary embolism (PE). His clinical condition deteriorated despite regular heparin and thrombolytic agent treatment, and he eventually developed cardiogenic shock. A thrombus originating from the inferior vena cava was detected and acute-on-chronic embolization resulted, with an unusual clinical course. Aggressive catheter thrombectomy with pigtail rotation failed to fragment the organized thrombus, but it was successfully removed by a 3-loop snare device combined with guiding catheter under percutaneous cardiopulmonary support.