Step-by-Step ICE-Guided Aspiration Thrombectomy: Gastrointestinal Bleeding Patient With Device-Related Thrombus on Watchman FLX

Authors

Leo Kar Lok Lai, Henry Ford HealthFollow
Hussayn Alrayes, Henry Ford HealthFollow
Georgi Fram, Henry Ford HealthFollow
James C. Lee, Henry Ford HealthFollow
Bryan Zweig, Henry Ford HealthFollow
Brian P. O'Neill, Henry Ford HealthFollow
Tiberio M. Frisoli, Henry Ford HealthFollow
Pedro Engel Gonzalez, Henry Ford HealthFollow
William W. O'Neill, Henry Ford HealthFollow
Pedro A. Villablanca, Henry Ford HealthFollow

Recommended Citation

Lai LKL, Alrayes H, Fram G, Lee JC, Zweig B, O'Neill BP, Frisoli TM, Gonzalez PE, O'Neill WW, and Villablanca PA. Step-by-Step ICE-Guided Aspiration Thrombectomy: Gastrointestinal Bleeding Patient With Device-Related Thrombus on Watchman FLX. JACC Case Rep 2025; 30(3).

Document Type

Article

Publication Date

2-5-2025

Publication Title

JACC Case Rep

Abstract

OBJECTIVES: Device-related thrombus (DRT) remains a significant complication in the field of left atrial appendage occlusion (LAAO). In patients who have difficulty tolerating long-term anticoagulation, treatment options are limited. We present a step-by-step intracardiac echocardiography (ICE)-guided AngioVac (AngioDynamics) challenging case in a 71-year-old woman with a gastrointestinal bleeding tendency and a highly mobile thrombus on a Watchman FLX device (Boston Scientific).

KEY STEPS: We obtained a 26-F DrySeal (Gore Medical) venous access, a 15-F extracorporeal membrane oxygenation cannula arterial access, and a 3-dimensional ICE access. We performed a challenging transseptal crossing using an Agilis medium curl catheter (Abbott) and an electrified Astato wire (Asahi Intecc Medical) as a result of a severely hypertrophic lipomatous septum. We snared the ICE catheter across the interatrial septum (IAS) with a 35-mm gooseneck snare in the inferior vena cava. We used a balloon-assisted technique to bring the F-18 AngioVac system across the IAS. The helicoptering technique with a J-wire assisted with suction of the DRT.

POTENTIAL PITFALLS: Currently, there are no data to support which post-LAAO antithrombotic regimen predicts DRT. For patients who are unable to tolerate long-term anticoagulation, treatment options are limited. To our knowledge, this is the first reported ICE-guided LAAO thrombus aspiration.

TAKE-HOME MESSAGES: ICE-guided aspiration thrombectomy of LAAO thrombus is feasible in high-risk patients who cannot tolerate long-term oral anticoagulation and to reduce the risk of clot embolization.

PubMed ID

39963229

Volume

30

Issue

3

First Page

103219

Last Page

103219