Shin Lee Han, Ordookhanian Christ, Amidon Ryan, Tabibian Benjamin
Internal Medicine, University of California, Riverside School of Medicine, Riverside, USA.
Internal Medicine, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, USA.
Eur J Case Rep Intern Med. 2025 Aug 18;12(9):005695. doi: 10.12890/2025_005695. eCollection 2025.
Pulmonary embolism (PE) is a life-threatening condition with well-defined management strategies; however, the presence of a clot-in-transit (CIT)-a mobile thrombus within the right heart-introduces a uniquely high-risk scenario associated with a significantly elevated mortality rate. While several therapeutic approaches are available-including anticoagulation, systemic thrombolysis, surgical embolectomy, and catheter-directed therapies-there is no established consensus on a superior treatment modality. Catheter-based mechanical thrombectomy has emerged as a promising, minimally invasive alternative that mitigates the bleeding risks of systemic thrombolysis and the invasiveness of surgery.
A 37-year-old male with untreated rheumatoid arthritis presented to the emergency department with dyspnea and chest pain, ultimately found to have massive bilateral PE with CIT. This was successfully treated with percutaneous thrombectomy using the INARI FlowTriever device (Inari Medical, USA).
This case is accompanied by uncommon post-thrombectomy imaging that vividly demonstrates the thrombus burden in the majority of bilateral pulmonary vessels, providing valuable visual insight into the disease process and intervention efficacy. Rheumatoid arthritis is an independent risk factor for PE, deep vein thrombosis, and venous thromboembolism, highlighting the importance of treatment.
This report contributes to the limited literature on atypical CIT presentations, highlights the need for standardized treatment algorithms, and demonstrates the success of catheter-directed mechanical thrombectomy in these scenarios.
Rheumatoid arthritis is a risk factor for pulmonary embolism, deep vein thrombosis, and venous thromboembolism.Catheter-directed mechanical thrombectomy for massive pulmonary embolism with clot-in-transit is a promising, minimally invasive alternative to systemic thrombolysis.
肺栓塞（PE）是一种危及生命的疾病，有明确的治疗策略；然而，存在移行性血栓（CIT）——右心内的移动血栓——会带来一种独特的高风险情况，死亡率显著升高。虽然有几种治疗方法可供选择，包括抗凝、全身溶栓、外科血栓切除术和导管导向治疗，但对于哪种治疗方式更优尚无定论。基于导管的机械血栓切除术已成为一种有前景的微创替代方法，可降低全身溶栓的出血风险和手术的侵入性。
一名37岁未接受治疗的类风湿性关节炎男性因呼吸困难和胸痛就诊于急诊科，最终被诊断为双侧大面积肺栓塞合并CIT。使用INARI FlowTriever装置（美国Inari Medical公司）经皮血栓切除术成功治疗了该病例。
该病例伴有不常见的血栓切除术后影像学表现，清晰地显示了大多数双侧肺血管内的血栓负荷，为疾病过程和干预效果提供了有价值的视觉见解。类风湿性关节炎是肺栓塞、深静脉血栓形成和静脉血栓栓塞的独立危险因素，凸显了治疗的重要性。
本报告为关于非典型CIT表现的有限文献做出了贡献，强调了标准化治疗算法的必要性，并证明了导管导向机械血栓切除术在这些情况下的成功。
类风湿性关节炎是肺栓塞、深静脉血栓形成和静脉血栓栓塞的危险因素。对于伴有移行性血栓的大面积肺栓塞，导管导向机械血栓切除术是一种有前景的微创替代全身溶栓的方法。
