Related Experiment Video
Updated: Feb 7, 2026

A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
ICE-Guided Percutaneous Thrombectomy of Thrombus-in-Transit With Impending Paradoxical Embolism Through PFO and
Timothy Ho Him Kam1, Cheuk Yin Lai1, Leo Kar Lok Lai1
1Division of Cardiology, Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, China.
Objective:
Impending paradoxical embolism (IPE), defined as thrombus entrapped across a patent foramen ovale, is rare in acute pulmonary embolism (PE) and is associated with high mortality. We present to our knowledge the first successful intracardiac echocardiography (ICE)-guided mechanical thrombectomy for simultaneous treatment of right ventricular thrombus-in-transit (TIT), IPE, and high-risk PE.
Key Steps:
ICE was used to locate the mobile TIT straddling the patent foramen ovale. For embolic protection, a Sentinel cerebral protection system was deployed via the right radial artery, while a blocking balloon positioned in the left subclavian artery. A 24-F femoral venous access enabled advancement of the AlphaVac F1885 system into the right atrium. Under ICE guidance, aspiration evacuated the TIT and IPE, followed by catheter-based pulmonary thrombectomy.
Potential Pitfalls:
Percutaneous thrombectomy is feasible for patients unsuitable for surgery or thrombolysis but carries a risk of paradoxical embolization. Embolic protection is therefore essential.
Take-Home Message:
ICE-guided AlphaVac thrombectomy of TIT, IPE, and PE is feasible in high-risk patients.
Related Concept Videos
Pulmonary Embolism I: Introduction
Pulmonary Embolism III: Nursing Management
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Upward Impending Motion
To better comprehend how a screw jack functions, consider the completely unraveled thread as a block in contact with the...
Phase Transitions
Phase Transitions: Sublimation and Deposition

