Concomitant AngioVac thrombectomy and patent foramen ovale closure in a patient with a large right atrial thrombus and recent paradoxical embolic stroke
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Interventional Radiology - Technical Note
P: 272-274
March 2021

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

Diagn Interv Radiol 2021;27(2):272-274
1. Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, California, USA
2. UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, USA
3. Division of Pediatric Cardiology, Department of Pediatrics, University of California, Los Angeles, California, USA
No information available.
No information available
Received Date: 05.05.2020
Accepted Date: 05.06.2020
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ABSTRACT

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.