Kim Kang Woo, Wheeler Mareril, Schneider Franklin, Carino Gerardo
Internal Medicine, Brown University, Providence, USA.
Pulmonary and Critical Care, Brown University, Providence, USA.
Cureus. 2023 Oct 7;15(10):e46636. doi: 10.7759/cureus.46636. eCollection 2023 Oct.
This case report investigates the management of a clot in transit (CIT), a rare but possibly life-threatening condition discovered in a small percentage of pulmonary embolism (PE) cases. CITs are thrombi lodged within the right-side heart chambers or the major veins, and there are currently no universal guidelines for their management though the literature has shown reduced mortality with reperfusion therapy compared to anticoagulation alone. In this case, a 96-year-old male who presented with a submassive PE was initially stabilized with anticoagulation and was then discovered to have a CIT with adherence to the tricuspid valve. The patient underwent a successful mechanical thrombectomy using the Inari FlowTriever (Inari Medical, Irvine, CA), an FDA-approved device for CIT removal. Overall, this manuscript supports this percutaneous intervention in intermediate to high-risk PE patients with concomitant CIT, offering an alternative to thrombolysis and cardiothoracic surgery, which carry their own risks. Furthermore, the unique characteristic of the CIT in this patient suggests a potential for further investigation into the diversity of CIT morphology and its significance.
本病例报告探讨了漂浮血栓（CIT）的处理，这是一种在少数肺栓塞（PE）病例中发现的罕见但可能危及生命的情况。CIT是位于右心腔或大静脉内的血栓，目前尚无针对其处理的通用指南，不过文献显示与单纯抗凝治疗相比，再灌注治疗可降低死亡率。在本病例中，一名96岁男性因亚大块肺栓塞就诊，最初通过抗凝治疗病情稳定，随后发现其患有附着于三尖瓣的漂浮血栓。该患者使用Inari FlowTriever（Inari Medical，尔湾，加利福尼亚州）成功进行了机械血栓切除术，这是一种经美国食品药品监督管理局（FDA）批准用于清除CIT的设备。总体而言，本手稿支持对伴有CIT的中高危PE患者进行这种经皮干预，为有自身风险的溶栓和心胸外科手术提供了一种替代方案。此外，该患者漂浮血栓的独特特征提示了进一步研究CIT形态多样性及其意义的潜力。
