Large-bore rotational thrombectomy and balloon angioplasty for thrombus fragmentation and removal from occluded iliofemoral or inferior vena cava stents.

Although venous stent placement is an established treatment for patients with deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS), stent patency rate may be as low as 80% at 12 months. Treatment of stent occlusion requires the removal of a large amount of fresh or organized thrombus from stents with a diameter of 12-20 mm. The feasibility of large-bore rotational thrombectomy in combination with angioplasty to treat thrombosed venous iliofemoral or inferior vena cava stents has not been investigated yet. Between May 2023 and June 2024, 12 patients (15 limbs) with symptomatic venous stent occlusions were treated at our institution with the 10-French Rotarex™ thrombectomy device and completed 3-month follow-up by Duplex ultrasound. The primary outcome was primary patency at 90 days after thrombectomy of stent occlusion. Safety outcomes included device-related complications, bleeding, and death. Median age was 41 years, 75% were women. At the index procedure, 10 (83%) patients presented with PTS and two (17%) with acute DVT. Median time from index procedure to re-intervention was 1125 (Q1-Q3: 897-2297) days and from symptom onset to re-intervention 39 (Q1-Q3: 8-186) days. Technical success of re-intervention was achieved in all cases, and bail-out stent-in-stent placement was not required in 5 (33%) limbs. The primary patency rate at 90 days was 86.7% (95% CI: 71.0-100.0). Two (17%) patients experienced recurrent stent thrombosis and were managed conservatively. Peri-interventional minor bleeding occurred in two (17%) patients. There were no device-related complications, major bleeding, or deaths. Large-bore rotational thrombectomy appears to be a feasible strategy to treat iliofemoral and inferior vena cava stent thrombosis, achieving acceptable short-term patency without major adverse events.