Concomitant AngioVac thrombectomy and patent foramen ovale closure in a patient with a large right atrial thrombus and recent paradoxical embolic stroke

• Published in: Diagnostic and interventional radiology (Ankara, Turkey) Vol. 27; no. 2; pp. 272 - 274
• Main Authors: E Callese, Tyler, H Yang, Eric, Levi, Daniel, N Srinivasa, Ravi, M Moriarty, John
• Format: Journal Article
• Language: English
• Published: Turkey Galenos Yayinevi Tic. Ltd 01-03-2021; Aves Yayincilik Ltd. STI; Turkish Society of Radiology; Galenos Publishing House
• Subjects: Blood clots; Blood vessels; Care and treatment; Case studies; Constellations; Coronary thrombosis; Emergency medical services; Emergency vehicles; Gallbladder; Infarction; Interventional Radiology: Technical Note; Propagation; Stroke; Stroke (Disease); Surgery; Thrombosis; United States
• ISSN: 1305-3612; 1305-3825; 1305-3612
• DOI: 10.5152/dir.2021.20291

A 59-year-old male with a history of gallbladder adenocarcinoma receiving chemotherapy and on therapeutic anticoagulation for portal vein thrombosis presented to the emergency department via ambulance after being found unresponsive and in cardiac arrest. Initial workup upon return of spontaneous circulation revealed a large right atrial mass, patent foramen ovale (PFO), and bilateral acute cortical infarctions. This constellation of findings were concerning for PFO-related paradoxical embolic strokes. Given the risk of recurrent paradoxical embolic events and the absolute contraindication to thrombolysis due to recent cerebral infarction, the decision was made to proceed with percutaneous vacuum-assisted thrombectomy using the AngioVac device. To prevent intraoperative thrombus propagation, PFO-closure was performed immediately prior to thrombectomy. Aspiration thrombectomy and PFO-closure were successful with complete thrombus removal and no intraoperative thrombus propagation. This case presents a minimally invasive and rapid treatment for a complex problem. An efficient and effective interdisciplinary team-based approach allowed the patient to resume cancer treatment relatively unabated.