Percutaneous Retrieval of an Intracardiac Cement Embolus Using a Modified Flower Technique

To show how a brittle cement embolus in the heart can be removed percutaneously after vertebral augmentation.

Place a large outer sheath in the internal jugular vein. Cut the tip of an inner sheath lengthwise in 3 places. Snare the embolus. Pull it back so that the strips open outward and cover it. Withdraw the inner sheath and embolus together as one smooth piece.

Cement is brittle, and the usual failure is breakage rather than loss of grip. Keep the force low and size the outer sheath to the loaded assembly. Strong traction to align the embolus with the sheath can break it. Ensure cardiac surgical backup and monitor for pericardial effusion.

A slit inner sheath opens outward around the snared embolus, so the brittle cement can be withdrawn intact.