EuroPCR2026-images-101685-Stuck-rock-hard-(get)-place

This is an unusual case of a PE with its transition tracked by transthoracic echocardiography initially as a large, highly mobile mass within right atrium, prolapsing across the tricuspid valve into the right ventricle in diastole. A second ECHO after her chest pain showed only small amounts of clot was left on the valve with a CTPA showing the right main pulmonary artery (PA) now blocked (dislodgement of thrombus from RA: clot in transit). Because the clot was well organised into a large egg-shaped size it was not possible to perform a successful mechanical pulmonary embolectomy. Pulmonary arteriogram (in this image) showed a very large, consolidated clot with very poor perfusion of right side of lung with loss of multiple branches. The RV pressure 58/4mmHg was consistent with PHT with a recorded right PA pressure 58/20mmHg (mean 32mmHg). Inari T20 taken from proximal to distal positions to aspirate resulted in no clot extraction even when using discs to attempt to macerate the clot with multiple passes or by employing the smaller T14 within the T20 in a mother and child approach. The patient was therefore managed conservatively with OAC as she was deemed high risk for surgical embolectomy.

 

This is an unusual case of a PE with its transition tracked by transthoracic echocardiography initially as a large, highly mobile mass within right atrium, prolapsing across the tricuspid valve into the right ventricle in diastole. A second ECHO after her chest pain showed only small amounts of clot was left on the valve with a CTPA showing the right main pulmonary artery (PA) now blocked (dislodgement of thrombus from RA: clot in transit). Because the clot was well organised into a large egg-shaped size it was not possible to perform a successful mechanical pulmonary embolectomy. Pulmonary arteriogram (in this image) showed a very large, consolidated clot with very poor perfusion of right side of lung with loss of multiple branches. The RV pressure 58/4mmHg was consistent with PHT with a recorded right PA pressure 58/20mmHg (mean 32mmHg). Inari T20 taken from proximal to distal positions to aspirate resulted in no clot extraction even when using discs to attempt to macerate the clot with multiple passes or by employing the smaller T14 within the T20 in a mother and child approach. The patient was therefore managed conservatively with OAC as she was deemed high risk for surgical embolectomy.