The Role of Large-Bore Mechanical Thrombectomy Devices in Tumor Thrombus

Tumor thrombus presents specific challenges, with patients requiring thrombus removal for diagnosis, staging, symptom relief, or curative treatment; however, many patients are not offered intervention due to risks and low success rate of traditional options. In select patients open surgical thrombectomy remains the standard curative approach but carries significant morbidity. Large-bore mechanical thrombectomy devices may provide a minimally invasive alternative with potential diagnostic and therapeutic capabilities.

A retrospective, single-center study (January 2022-June 2025) included seven consecutive oncological patients undergoing endovascular mechanical thrombectomy for venous or pulmonary tumor thrombus. Primary outcomes were diagnostic yield and procedural safety; secondary outcomes included restoration of vessel patency, symptom improvement, and impact on oncological management.

Seven patients, four male, median age 73 years old (range 55-80) underwent thrombectomy across renal, caval, iliac, and pulmonary vascular beds. There were no procedural complications. Mean estimated blood loss was 40 ml (0-240 mL). Diagnostic tissue was obtained in all patients. Technical success with restoration of patency and symptomatic improvement occurred in six patients (86%), with 1 failure due to tumor wall invasion. Oncologic management was influenced in all cases, including two renal cell carcinoma patients who proceeded to curative nephrectomy following thrombectomy.

This observational study demonstrates the feasibility of large-bore mechanical thrombectomy devices for oncological patients with tumor thrombus in a small case series and may be an option in select cases at the discretion of the operator and multidisciplinary team.