Transfemoral Retrograde Transcatheter Mechanical Thrombectomy of Massive Left Ventricular Thrombus

Left ventricular thrombus remains a clinically significant and under-recognized source of embolic complications in patients with left ventricular dysfunction. Transcatheter thrombectomy offers a viable alternative in high-risk surgical patients.

A 64-year-old woman with history of anterior acute myocardial infarction presented as a code stroke given sudden-onset dysarthria and right-sided facial droop. Brain magnetic resonance imaging revealed several acute infarcts in the left middle cerebral artery territory, consistent with embolic phenomenon. Transthoracic echocardiography demonstrated mildly reduced left ventricular ejection fraction of 44%, apical akinesis, and the presence of multiple large mobile left ventricular thrombi adherent to a papillary muscle and chordal apparatus, the largest measuring 2.1 × 2.0 cm. Transcatheter left ventricular thrombectomy using the AngioVac system was pursued using a retrograde transaortic approach.

Transcatheter thrombectomy is a safe alternative for patients with left-sided intracardiac masses who are at high risk for surgery. Trans-septal or retrograde transaortic approaches may be used for mass extraction.