A Novel Case of Cardiac Tamponade after Percutaneous Pulmonary Embolectomy Using the FlowTriever Retrieval/Aspiration...

Area of Science:

• Cardiology
• Interventional Radiology
• Vascular Surgery

Background:

• Pulmonary embolism (PE) poses significant mortality risks, especially in intermediate- to high-risk cases.
• Percutaneous mechanical thrombectomy, particularly using large-bore aspiration systems like FlowTriever, offers a promising alternative to traditional treatments for reducing clot burden.
• While effective, these advanced procedures necessitate specialized expertise and carry inherent risks.

Purpose of the Study:

• To report a rare complication associated with the FlowTriever system during percutaneous embolectomy for pulmonary embolism.
• To highlight the potential for cardiac micro-perforation and subsequent tamponade as a complication of this intervention.
• To underscore the importance of specialized training and vigilance for safety in percutaneous embolectomy.

Main Methods:

• A case study of a 45-year-old woman with intermediate- to high-risk PE who underwent percutaneous intervention.
• Utilized the FlowTriever retrieval/aspiration system for clot removal.
• Management of post-procedural complications including cardiac arrest and pericardial tamponade.

Main Results:

• The patient experienced cardiac arrests secondary to pericardial tamponade post-procedure.
• Pericardiocentesis was required for hemodynamic stabilization.
• This represents the first documented instance of FlowTriever system use leading to right ventricular micro-perforation and subsequent cardiac arrest.

Conclusions:

• Percutaneous mechanical thrombectomy with devices like FlowTriever can be crucial in managing intermediate- to high-risk PE, offering immediate hemodynamic improvement.
• Cardiac micro-perforation is a potential, albeit rare, complication of catheter-based embolectomy devices.
• Clinicians must maintain a high index of suspicion for pericardial effusion and tamponade following such procedures.